CLINICAL SIGNS OF DEEP-VEIN THROMBOSIS

SummaryIn order to investigate whether a more intensive initial oral anticoagulation still would be safe and effective, we performed a prospective randomized study in patients with deep vein thrombosis. They received either the conventional regimen of oral anticoagulation (“low-dose”) and heparin or a more intense oral anticoagulation (“high-dose”) with a shorter period of heparin treatment.In the first part of the study 129 patients were randomized. The “low-dose” group reached a stable therapeutic prothrombin complex (PT)-level after 4.3 and the “high-dose” group after 3.3 days. Heparin was discontinued after 6.0 and 5.0 days respectively. There was no difference in significant hemorrhage between the groups, and no clinical signs of progression of the thrombosis.In the second part of the study another 40 patients were randomized, followed with coagulation factor II, VII, IX and X and with repeated venograms. A stable therapeutic PT-level was achieved after 4.4 (“low-dose”) and 3.7 (“high-dose”) days, and heparin was discontinued after 5.4 and 4.4 days respectively. There were no clinical hemorrhages, the activity of the coagulation factors had dropped to the same level in both groups at the time when heparin was discontinued and no thromboembolic complications occurred.Our oral anticoagulation regimen with heparin treatment for an average of 4.4-5 days seems safe and reduces in-patient costs.

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Correlation of clinical features with the risk of lower limb deep vein thrombosis assessed by duplex ultrasound

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492013000200005 ◽

2013 ◽

Vol 12 (2) ◽

pp. 118-122

Author(s):

Liz Andrea Villela Baroncini ◽

Graciliano Jose Franca ◽

Aguinaldo de Oliveira ◽

Enrique AntonioVidal ◽

Carlos Eduardo Del Valle ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Clinical Symptoms ◽

Clinical Signs ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Vein Thrombosis ◽

Below The Knee ◽

Clinical Conditions ◽

Deep Vein

BACKGROUND: Symptoms and clinical signs suggestive of deep vein thrombosis (DVT) are common but may have numerous possible causes. OBJECTIVES: 1) To identify the most frequent clinical symptoms and correlate them with duplex ultrasound scan (DS) findings; 2) to identify high-risk clinical conditions for DVT; and 3) to evaluate time since the onset of symptoms and DS examination. METHODS: A total of 528 patients with a clinical suspicion of DVT were evaluated by DS performed by experienced vascular ultrasonographists. RESULTS: DVT was present in 192 (36.4%) of the patients. The external iliac vein was involved in 53 patients (10.04%), the femoral veins in 110 (20.83%), the popliteal vein in 124 (23.48%), and veins below the knee were involved in 157 (29.73%) of the cases. Limb swelling was present in 359 cases (68%), and 303 (57.4%) complained of pain. Sixty nine patients received a DS due to suspected or proven pulmonary embolism (PE); 79 patients were in postoperative period. In the multivariate analysis, independent risk factors for DVT included age>65 years (OR=1.49; 95% confidence interval [95%CI] 1.01-2.18; p=0.042), edema (OR=2.83; 95%CI 1.72-4.65; p<0.001), pain (OR=1.99; 95%CI 1.3-3.05; p=0.002), cancer (OR=2.32; 95%CI 1.45-3.72; p<0.001), and PE (OR=2.62; 95%CI 1.29-5.32; p=0.008).Time since the onset of symptoms did not differ between the groups. CONCLUSIONS: In the present study, 36.4% of the patients referred to DS had DVT. Age > 65 years, presence of limb swelling, pain, cancer, and suspected or proven PE should be considered as major risk factors for DVT.

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On the Significance of Antithrombin-III, α2-Macroglobulin, α2-Antiplasmin, Histidine-Rich Glycoprotein, and Protein C in Patients with Acute Myocardial Infarction and Deep Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657883 ◽

1985 ◽

Vol 54 (02) ◽

pp. 503-505 ◽

Cited By ~ 7

Author(s):

Jørgen Gram ◽

Jørgen Jespersen

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Deep Vein Thrombosis ◽

Longitudinal Study ◽

Protein C ◽

Antithrombin Iii ◽

Clinical Signs ◽

Vein Thrombosis ◽

Α2 Macroglobulin ◽

Deep Vein

SummaryIn a longitudinal study the plasma levels of antithrombin-III, α2-macroglobulin, α2-antiplasmin, histidine-rich glycoprotein, and protein C were followed in two groups of patients with acute myocardial infarction (AMI), one with and one without deep vein thrombosis (DVT). None of the sequentially studied periods revealed significant differences between the two groups of patients. However, small but consistently higher levels of histidine-rich glycoprotein in patients with DVT suggested the existence among patients submitted for myocardial infarction of a subgroup with increased thrombophilic potential. It was concluded that the inhibitors studied are of little value as possible indicators of the presence of DVT at early stages of the disease when clinical signs are absent and when antithrombotic prophylaxis should preferably be initiated.

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CLINICAL SIGNS IN DEEP VEIN THROMBOSIS

Obstetrical & Gynecological Survey ◽

10.1097/00006254-197111000-00007 ◽

1971 ◽

Vol 26 (11) ◽

pp. 757-758

Author(s):

CHRISTINE M. HALL ◽

C. G. CLARK

Keyword(s):

Deep Vein Thrombosis ◽

Clinical Signs ◽

Vein Thrombosis ◽

Deep Vein

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A study on the effectiveness of wells criteria for diagnosing deep vein thrombosis: a prospective observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20210365 ◽

2021 ◽

Vol 8 (2) ◽

pp. 569

Author(s):

Dhanaraj Palanisamy ◽

Akshay Omkumar

Keyword(s):

Deep Vein Thrombosis ◽

Single Case ◽

Post Partum ◽

Clinical Signs ◽

Study Group ◽

Cortical Vein ◽

Vein Thrombosis ◽

Cortical Vein Thrombosis ◽

Wells Score ◽

Deep Vein

Background: Wells score which takes into account various aspects in the history as well as various clinical signs which can help the clinician to arrive at a diagnosis of deep vein thrombosis (DVT). This helps to save time and money that is wasted in doing many unnecessary investigations. Aim of the study was to test the application of the Wells score in our clinical set up and to see how effectively we can diagnose DVT.Methods: This was a prospective diagnostic validation study of the wells rule for DVT in our setup, ultrasound (USG) being the gold standard comparison and will be conducted over a duration of 12 months. Wells score for each patient was calculated and the results were evaluated.Results: Among the 50 cases suspected DVT, the wells score was able to predict DVT in 46 of the cases thus proving to be a very efficient diagnostic indicator. The average wells score among the various cases was 4/8. Complications noted in the study group were 2 cases of cortical vein thrombosis in the post-partum period which fully recovered. Mortality rate in the study group was 4.3% in which a single case of diagnosed myocardial infarction died of heart failure.Conclusions: Wells score is indeed a very good predictive criteria for DVT and can be applied with ease as it required only clinical assessment and thus avoids unnecessary delays in waiting for scans thereby allowing us to start anticoagulants as early as possible.

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P136: Evaluating the use of the YEARS clinical decision rule for diagnosing pulmonary embolism in the Emergency Department

CJEM ◽

10.1017/cem.2018.334 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S105-S105 ◽

Cited By ~ 1

Author(s):

S. Sharif ◽

C. Kearon ◽

M. Eventov ◽

M. Li ◽

R. Jiang ◽

...

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

False Negative ◽

False Negative Rate ◽

Clinical Signs ◽

Vein Thrombosis ◽

Negative Rate ◽

Deep Vein ◽

D Dimer

Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based algorithms are not always adhered to in the Emergency Department (ED) and are often not used correctly, which leads to unnecessary CT scanning. The YEARS diagnostic algorithm, consisting of three items (clinical signs of deep vein thrombosis, hemoptysis, and whether pulmonary embolism is the most likely diagnosis) and D-dimer, is a novel and simplified way to approach suspected acute PE. The purpose of this study was to 1) evaluate the use of the YEARS algorithm in the ED and 2) to compare the rates of testing for PE if the YEARS algorithm was used. Methods: This was a health records review of ED patients investigated for PE at two emergency departments over a two-year period (April 2013-March 2015). Inclusion criteria were ED physician ordered CT pulmonary angiogram, ventilation-perfusion scan, or D-dimer for investigation of PE. Patients under the age of 18 and those without a D-dimer test were excluded. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30 days. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the false negative rate was calculated. Results: There were 1,163 patients that were tested for PE and 1,083 patients were eligible for our analysis. Of the total, 317/1,083 (29.3%; 95%CI 26.6-32.1%) had CT/VQ imaging for PE, and 41/1,083 (3.8%; 95%CI 2.8-5.1%) patients were diagnosed with PE at baseline. Three patients had a missed PE, resulting in a false negative rate of 0.4% (95%CI 0.1-1.2%). If the YEARS algorithm was used, 211/1,083 (19.5%; 95%CI 17.2-22.0%) would have required imaging for PE. Of the patients who would not have required imaging according to the YEARS algorithm, 8/872 (0.9%; 95%CI 0.5-1.8%) would have had a missed PE. Conclusion: If the YEARS algorithm was used in all patients with suspected PE, fewer patients would have required imaging with a small increase in the false negative rate.

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Epidemioclinical profile and management of post thrombotic syndrome in Antananarivo

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v10i6-s.4420 ◽

2020 ◽

Vol 10 (6-s) ◽

pp. 16-21

Author(s):

TSIRIMALALA Rajaobelison ◽

ZAKARIMANANA LUCAS Randimbinirina ◽

RNAL Rakotorahalahy ◽

AML Ravalisoa ◽

AJC Rakotoarisoa

Keyword(s):

Deep Vein Thrombosis ◽

Anticoagulant Therapy ◽

Varicose Veins ◽

Previous History ◽

Clinical Signs ◽

Compression Stockings ◽

Early Management ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Deep Vein

Introduction: The post-thrombotic syndrome (PTS) is the most complication of deep vein thrombosis who deserves an early management. The aim of this study was to determine the epidemio-clinical profile and the management of PTS. Methods: This was a retrospective and descriptive study for a period of 6 years from January 2013 to December 2018, performed at the Cardiovascular Surgery Unit in JRA Teaching Hospital Antananarivo, including all patients who presented post-thrombotic syndrome after an acute episode of deep venous thrombosis. Results: 106 patients were recorded among 315 patients who presented an episode of DVT (33.65%) and 14110 patients admitted in this period (0.75%). The average age was 46.18 years old. There were 30 males (28.30%) and 76 female (71.69%). The most important risk factors of PTS were previous history of varicose veins (50%), sedentary lifestyle (45.28%), insufficiency of anticoagulant therapy (68.86%) and proximal DVT (47.16%). Delayed of diagnosis were greater than or equal to 2 years after an acute DVT in 86 patients (81.13%). The most clinical signs were edema (56.60%) and varicose veins (54.71%). According the Villalta’s score, PTS were mild in 48 patients (45.28%), moderate in 47 patients (44.33%) and severe in 11 patients (10.37%). Management was lifestyles change (45.28%), compression stockings (100%), anticoagulant therapy (100%) and surgical treatment (65.09%). Conclusion: The frequency of PTS was 33.65% in our study. PTS reduces quality of life of patients, but it can be avoided if the treatments of DVT are adapted. Keywords: Deep vein thrombosis, Post-thrombotic syndrome, Epidemiology, Management

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RATE OF NORMALIZATION OF ABNORMAL IMPEDANCE PLETHYSMOGRAPHY IN PATIENTS WITH PROVEN DEEP VEIN THROMBOSIS: SIGNIFICANCE IN THE MANAGEMENT OF RECURRENT SYMPTOMS

10.1055/s-0038-1642894 ◽

1987 ◽

Author(s):

M V Huisman ◽

H R Buller ◽

J W ten Cate

Keyword(s):

Deep Vein Thrombosis ◽

Prospective Trial ◽

Clinical Signs ◽

Signs And Symptoms ◽

Impedance Plethysmography ◽

Vein Thrombosis ◽

Clinical Signs And Symptoms ◽

One Year ◽

The One ◽

Deep Vein

The diagnosis of deep vein thrombosis (DVT) by clinical signs and symptoms is unreliable, but contrast venography is expensive and invasive. Therefore, the use of non-invasive methods to detect DVT have become en vogue, of which impedance plethysmography (IPG), either in combination with 125x fibrinogen leg scanning or performed serially as a single test, have been demonstrated to be a safe and effective alternative. Since the principle of IPG is based on the measurement of venous outflow obstruction due to intravascular thrombus and since the aim of anticoagulant treatment is to facilitate recanalisation one might expect a gradual normalisation of IPG in the majority of patients. This information is important for patients presenting with recurrent signs and symptoms. If the IPG has normalized prior to presentation it is possible to separate complaints due to recurrent DVT from post phlebitic syndrome. In this prospective trial we studied 161 consecutive outpatients with abnormal IPG and venography proven DVT three monthly during one year to determine the rate of normalization and to estimate the utility of IPG testing in patients with recurrent symptomatic DVT. The IPG test had normalized in 101 of 151 patients (67%) by three months, in 126 of 148 (85%) after six months, in 133 of 145 (92%) while after one year 139 of 146 (95%) had their IPG normalized. During the one year follow-up 35 of the 161 study patients (23%) returned with recurrent symptoms. Of these 31 had normal IPG tests prior to the visit. In 18 patients IPG remained normal at repeat testing. In 13 patients IPG became again abnormal (venography showed acute on chronic DVT in 10 patients while 3 patients showed no acute DVT). It is concluded that a 95% normalization of IPG occurs and that IPG is useful in the management of recurrent symptoms.

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Clinical signs in deep-vein thrombosis

British Journal of Surgery ◽

10.1002/bjs.1800580205 ◽

1971 ◽

Vol 58 (2) ◽

pp. 101-104 ◽

Cited By ~ 7

Author(s):

Christine M. Hall ◽

C. G. Clark

Keyword(s):

Deep Vein Thrombosis ◽

Clinical Signs ◽

Vein Thrombosis ◽

Deep Vein

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How to Differentiate Recurrent Deep Vein Thrombosis from Postthrombotic Syndrome

Hämostaseologie ◽

10.1055/a-1171-0486 ◽

2020 ◽

Vol 40 (03) ◽

pp. 280-291

Author(s):

Gargi Gautam ◽

Tim Sebastian ◽

Frederikus A. Klok

Keyword(s):

Deep Vein Thrombosis ◽

Management Strategies ◽

Clinical Signs ◽

Clinical Findings ◽

Postthrombotic Syndrome ◽

Vein Thrombosis ◽

Diagnostic Standards ◽

Risk Of Progression ◽

Recurrent Deep Vein Thrombosis ◽

Deep Vein

AbstractVenous thromboembolism (VTE) is associated with significant morbidity and mortality. Accuracy of diagnosis is thus of vital importance. Failure to diagnose VTE increases the risk of progression and complications. Conversely, anticoagulation as a result of an incorrect diagnosis exposes patients to the associated hazards of bleeding. The diagnostic management of recurrent deep vein thrombosis (DVT) and postthrombotic syndrome (PTS) is especially challenging due to the lack of well-established diagnostic standards. Particularly, the differentiation between the two is notoriously difficult as symptoms, clinical signs, and diagnostic test findings largely overlap. This review highlights the current diagnostic and management strategies for recurrent DVT and PTS with a focus on clinical findings and imaging modalities. We also discuss current open questions for clinicians in the field, anticipating future directions and predictions for the year 2050.

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