Failure of Computerized Impedance Plethysmography in the Diagnostic Management of Patients with Clinically Suspected Deep-Vein Thrombosis

1991 ◽  
Vol 65 (03) ◽  
pp. 233-236 ◽  
Author(s):  
P Prandoni ◽  
A W A Lensing ◽  
H R Büller ◽  
M Carta ◽  
M Vigo ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Clinical Medicine ◽  
Impedance Plethysmography ◽  
Diagnostic Modality ◽  
Vein Thrombosis ◽  
Diagnostic Management ◽  
Lower Ability ◽  
Abnormal Test Result ◽  
Deep Vein

SummaryBefore a new diagnostic modality can be introduced in clinical medicine, the validity of both a normal and abnormal test result have to be assessed prospectively in an appropriate patient group. We have evaluated the clinical validity of. a new computerized impedance plethysmography (CIP) in the diagnostic management of 381 consecutive patients with clinically suspected venous thrombosis. In patients with serially normal CIP results, the diagnosis of venous thrombosis was refuted and, consequently, they were not treated with anticoagulant therapy and all were followed up for a period of 6 months to estimate the occurrence of symptomatic venous thromboembolism.The study was prematurely terminated by the safety monitoring committee because of an unacceptably high incidence of confirmed venous thromboembolism (10 patients, 3.2%; 95% confidence interval: 1.6% to 6%), including 4 episodes of fatal pulmonary embolism. In a subsequent explanatory study using ultrasonography in 29 other symptomatic patients who had at least 2 repeated normal CIP test results, the failure of CIP to detect proximal vein thrombosis was confirmed in 4 patients (14%). The reasons for this failure are probably related to the use of a modified device to measure impedance in the CIP apparatus, resulting in a lower ability to separate patients without venous thrombosis from those with the disease.We concluded that CIP is insensitive for the detection of proximal vein thrombosis and, therefore, not clinically useful in the diagnostic management of patients with suspected venous thrombosis.

Deep Vein Thrombosis in Obstetric Patients: Diagnosis and Risk Factors

1992 ◽  
Vol 67 (01) ◽  
pp. 004-007 ◽  
Author(s):  
Karin de Boer ◽  
Harry R Büller ◽  
Jan W ten Cate ◽  
Marcel Levi
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Diagnostic Method ◽  
Clinical Symptoms ◽  
Impedance Plethysmography ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryThis study was performed to assess the prevalence of deep vein thrombosis (DVT) in consecutive obstetric patients with clinical symptoms of DVT, using impedance plethysmography (IPG) as the diagnostic method and to establish the safety of withholding anticoagulant therapy in patients with a repeatedly normal IPG. In addition, in patients with DVT the prevalence of coagulation and fibrinolytic disorders, which may explain the occurrence of venous thrombosis was investigated.Of the 77 obstetric patients with symptoms of DVT 32 (42%) had an abnormal IPG. The remaining 45 patients had a repeatedly normal IPG and showed no venous thromboembolism during a 6 months follow-up period. Twenty percent (six patients) of the patients with an abnormal IPG had a coagulation or fibrinolytic abnormality. These observations suggest that serial IPG can be used effectively in the management of obstetric patients with clinically suspected DVT and that hemostatic abnormalities are frequently found in those patients with DVT

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

scholarly journals Current Challenges in Diagnosis of Venous Thromboembolism

2020 ◽  
Vol 9 (11) ◽  
pp. 3509
Author(s):  
Zachary Liederman ◽  
Noel Chan ◽  
Vinai Bhagirath
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Cost Effective ◽  
Diagnostic Approach ◽  
Medical Patients ◽  
Vein Thrombosis ◽  
Non Invasive ◽  
Risk Patients ◽  
Diagnostic Framework ◽  
Deep Vein

In patients with suspected venous thromboembolism, the goal is to accurately and rapidly identify those with and without thrombosis. Failure to diagnose venous thromboembolism (VTE) can lead to fatal pulmonary embolism (PE), and unnecessary anticoagulation can cause avoidable bleeding. The adoption of a structured approach to VTE diagnosis, that includes clinical prediction rules, D-dimer testing and non-invasive imaging modalities, has enabled rapid, cost-effective and accurate VTE diagnosis, but problems still persist. First, with increased reliance on imaging and widespread use of sensitive multidetector computed tomography (CT) scanners, there is a potential for overdiagnosis of VTE. Second, the optimal strategy for diagnosing recurrent leg deep venous thrombosis remains unclear as is that for venous thrombosis at unusual sites. Third, the conventional diagnostic approach is inefficient in that it is unable to exclude VTE in high-risk patients. In this review, we outline pragmatic approaches for the clinician faced with difficult VTE diagnostic cases. In addition to discussing the principles of the current diagnostic framework, we explore the diagnostic approach to recurrent VTE, isolated distal deep-vein thrombosis (DVT), pregnancy associated VTE, subsegmental PE, and VTE diagnosis in complex medical patients (including those with impaired renal function).

scholarly journals Direct costs for treatment of venous thromboembolism complication 90-day after surgery

2019 ◽  
Vol 35 (2) ◽  
Author(s):  
Bui My Hanh ◽  
Duong Duc Tuan ◽  
Tran Tien Hung ◽  
Nguyen Huu Chinh ◽  
Kieu Thi Tuyet Mai
Keyword(s):  
Deep Vein Thrombosis ◽  
Health Insurance ◽  
Venous Thromboembolism ◽  
Propensity Score ◽  
Venous Thrombosis ◽  
Economic Impact ◽  
National Health Insurance ◽  
National Health ◽  
Vein Thrombosis ◽  
Deep Vein

Study object: Describe the direct treatment costs due to venous thromboembolism complications 90 days after surgery by using national health insurance reimbursement database. Patients: 824,947 adult patients who underwent major surgeries were enrolled from January 1, 2017 to September 31, 2018. Method: Study was conducted by using cross-sectional descriptive design. Patients were considered VTE case if they had a diagnostic code up to 90 days after the first surgery, thus 1472 were diagnosed as having VTE after surgery. The study using propensity score matching method shows that there were 913 pairs of patients with the same propensity score included in analysis. Results: The rate of hospital re-admission and outpatient visit were 41.7% and 60.8% in group of VTE patient after matching, respectively. The mean 90-day postoperative cost in VTE group after matching was found to be 89.652 ± 107.928 thousand VNĐ, which is 1.5 times higher than the expenditure of non-VTE group with 61.474± 81.115 thousand VNĐ. Conclusion: The costs related to VTE treatment can be used to evaluate the potential economic benefit and cost-savings from efforts of VTE prevention. Keywords Venous thromboembolism, direct treatment costs. References [1] W.H. Geerts, G.F. Pineo, J.A. Heit, et al, Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest 126 (2004) 338-400. https:// doi.org/10.1378/chest.126.3_suppl.338S.[2] V.V. Tam, N.V. Thong, The rate of deep venous thrombosis related to hip and knee arthroplasty – A study in Cho Ray Hospital (in Vietnamese), Ho Chi Minh City Medical Journal 18(2) (2014) 250-256.[3] A.C. Spyropoulos, J.S. Hurley, G.N. Ciesla, et al, Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin, Chest 122 (2002) 108-14. https://doi.org/10.1378/chest.122.1.108.[4] D.A. Ollendorf, M. Vera-Llonch ,G. Oster., Cost of venous thromboembolism following major orthopedic surgery in hospitalized patients, Am J Health Syst Pharm 59(18) (2002) 1750-4. https://doi.org/10.1093/ajhp/59.18.1750[5] J.Y.S. Ng, R.V. Ramadani, D. Hendrawan, et al,National Health Insurance Databases in Indonesia, Vietnam and the Philippines, Pharmacoecon Open (2019). https://doi.org/ 10.1007/s41669 -019-0127-2.[6] H. Assareh, J. Chen, L. Ou, et al, Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study, BMJ Open 4(10) (2014) 5502. https://doi.org/10.1136/bmjopen-2014-005502.[7] Agency for Healthcare Research and Quality (AHRQ), Patient safety indicator v4.5 benchmark data tables, (2013).[8] I.A. Naess, S.C. Christiansen, P. Romundstad, et al.,Incidence and mortality of venous thrombosis: a population-based study, J Thromb Haemost 5(4) (2007) 692-9. https://doi.org/10.1111/j.1538-7836.2007.02450.x.[9] D.C. Sutzko, P.E. Georgoff, A.T. Obi, et al, The Association Of Venous Thromboembolism Chemoprophylaxis Timing on Venous Thromboembolism After Major Vascular Surgery, J Vasc Surg 67(1) (2018) 262-271. https://doi.org/ 10.1016/j.jvs.2017.06.087.[10] F.A. Anderson, F.A. Spencer, Risk factors for venous thromboembolism, Circulation 107(23) (2003) 9-16. https://doi.org/ 10.1161/01.CIR.0000078 469.07362.E6[11] J. Lin, A.C. Spyropoulos, Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations, J Manag Care Pharm 13(6) (2007) 475-86. https://doi.org/10.18553/jmcp.2007.13.6.475[12] D.J. Tillman, S.L. Charland, D.M. Witt, Effectiveness and economic impact associated with a program for outpatient management of acute deep vein thrombosis in a group model health maintenance organization, Arch Intern Med, 160(19) (2000) 2926-32. https://doi.org/ 10.1001/archinte.160.19.2926.[13] M. Sakon, Y. Maehara, T. Kobayashi, et al, Economic Burden of Venous Thromboembolism in Patients Undergoing Major Abdominal Surgery, Value in Health Regional Issue 6 (2015) 73-79. https://doi.org/10.1016/j.vhri. 2015. 03.017.[14] A. Sepasso, F. Chingcuanco, E. Gordon, et al, Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study, Journal of Medical Economics 21(6) (2018) 595-602. https://doi.org/10.1080/13696998.2018.1445635.[15] Shinro Takai, Masao Akagi, Bruce Crawford, et al, Economic Impact of Venous Thromboembolism Following Major Orthopaedic Surgery in Japan, Value in Health Regional Issues 2(1) (2013) 81-86. https://doi.org/ 10.1016/j.vhri.2013.01.001.  

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

SAFETY AND EFFICACY OF SERIAL IMPEDANCE PLETHYSMOGRAPHY IN THE DIAGNOSIS OF DEEP VEIN THROMBOSIS IN AN URBAN HOSPITAL: AN EXTERNAL VALIDATION STUDY

1987 ◽  
Author(s):  
H H S Heyermans ◽  
M V Huisman ◽  
H R Büller ◽  
J V D Laan ◽  
J W ten Cate
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Oral Anticoagulants ◽  
External Validation ◽  
Hospital Setting ◽  
Impedance Plethysmography ◽  
Urban Hospital ◽  
Safety And Efficacy ◽  
Vein Thrombosis ◽  
Deep Vein

The clinical diagnosis of deep vein thrombosis (DVT) is unreliable. Impedance plethysmography (IPG) has become accepted as a highly reliable non-invasive method for DVT detection in symptomatic patients.It has a high sensitivity (95%) and specificity (96%) for proximal vein thrombosis. Studies with impedance plethysmography have however always been carried out in academic hospitals. To evaluate the safety and efficacy of serial impedance plethysmography alone in an urban hospital setting, a prospective study was done in an urban hospital, involving 234 consecutive outpatients with clinically suspected venous thrombosis. IPG was performed on days 1, 2 and 7. If all tesis remained normal the patient was not treated with oral anticoagulants. All patients were followed for 3 months. In 131 of the 234 patients (56%) IPG was repeatedly normal. Of these 131 patients, no patient died from venous thromboembolism during 3 months follow-up, completed in all patients, and no patient returned with signs of pulmonary embolism. One patient (0.8%) returned with objectively documented DVT after two months. In 103 of the 234 patients (44%) the IPG was abnormal. Venography confirmed the diagnosis of deep venous thrombosis in 92%.It is concluded that serial IPG is a safe and effective method to detect DVT in clinically suspected outpatients, referred to an urban hospital.

Treatment of Venous Thromboembolism

1999 ◽  
Vol 82 (08) ◽  
pp. 870-877 ◽  
Author(s):  
Shannon Bates ◽  
Jack Hirsh
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Clinical Problem ◽  
Treatment Modalities ◽  
Recurrent Thrombosis ◽  
Vein Thrombosis ◽  
Rate Of Dissolution ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
Common Clinical Problem

IntroductionVenous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common clinical problem. If untreated or inadequately treated, there is a high risk of fatal PE1 and recurrent venous thrombosis.2-4 The objectives of treatment are to prevent local extension of thrombus, embolization, and recurrent thrombosis.It is now widely accepted that VTE is a single disorder and, therefore, the treatment of venous thrombosis and PE is essentially the same. Four treatment modalities are available. Anticoagulant therapy prevents the growth of an existing thrombus or embolus, thrombolytic therapy accelerates the rate of dissolution of thrombi or emboli, caval interruption intercepts venous thrombi that break off and embolize, thereby preventing dangerous PE, and surgical therapy removes thrombi or emboli.

scholarly journals Arterial and Venous Thrombosis in Cancer Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Andrew D. Blann ◽  
Simon Dunmore
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Risk Groups ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Vein Thrombosis ◽  
Venous Circulation ◽  
Ultimate Cause ◽  
Myocardial Hypoxia ◽  
Deep Vein

The most frequent ultimate cause of death is myocardial arrest. In many cases this is due to myocardial hypoxia, generally arising from failure of the coronary macro- and microcirculation to deliver enough oxygenated red cells to the cardiomyocytes. The principle reason for this is occlusive thrombosis, either by isolated circulating thrombi, or by rupture of upstream plaque. However, an additionally serious pathology causing potentially fatal stress to the heart is extra-cardiac disease, such as pulmonary hypertension. A primary cause of the latter is pulmonary embolus, considered to be a venous thromboembolism. Whilst the thrombotic scenario has for decades been the dominating paradigm in cardiovascular disease, these issues have, until recently, been infrequently considered in cancer. However, there is now a developing view that cancer is also a thrombotic disease, and notably a disease predominantly of the venous circulation, manifesting as deep vein thrombosis and pulmonary embolism. Indeed, for many, a venous thromboembolism is one of the first symptoms of a developing cancer. Furthermore, many of the standard chemotherapies in cancer are prothrombotic. Accordingly, thromboprophylaxis in cancer with heparins or oral anticoagulation (such as Warfarin), especially in high risk groups (such as those who are immobile and on high dose chemotherapy), may be an important therapy. The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer.

Sign in / Sign up

Export Citation Format

Share Document