Diagnosis of Deep-Vein Thrombosis and Pulmonary Embolism: The New Guideline of the Dutch Institute for Health Care Improvement

2007 ◽  
Vol 11 (3) ◽  
pp. 3-7 ◽  
Author(s):  
P. W. Kamphuisen ◽  
M. Oudkerk
Keyword(s):  
Health Care ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Health Care Improvement ◽  
Care Improvement ◽  
Deep Vein

Lack of Difference In Co-Morbidities Associated with Deep Venous Thrombosis In Patients Undergoing Total Knee Replacement

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2578-2578
Author(s):  
Prabhu Viswanathan ◽  
Upasana Tiwari ◽  
Lakshmanan Krishnamurti
Keyword(s):  
Health Care ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Hip Replacement ◽  
Care Utilization ◽  
Vein Thrombosis ◽  
Total Knee ◽  
Deep Vein

Abstract Abstract 2578 Background: Thromboprophylaxis is the top challenge to patient safety practice in hospitals. Postoperative Deep vein thrombosis (DVT) and pulmonary embolism (PE) are the major cardiovascular killers in the surgical setting. In October 2008, Medicare designated DVT and PE occurring after total knee or hip replacement as ‘never events', and indicated that they will not pay the incremental cost to manage the complication and has made the hospital acquired DVT/PE unacceptable and serious. There are however, limited data on factors contributing to DVT/PE in-patients undergoing total knee or hip replacement. Aim: To ascertain nationwide health care utilization and associated co-morbidities in Total knee replacement (TKR) recipients who do or do not develop DVT/PE. Methods: We used the year 2007, National Inpatient Sample (NIS) to analyze the post operative occurrence of DVT/PE after TKR. We used an analysis similar to AHRQ's Patient Safety Indicator number – 12 (PSI 12) which is Postoperative Pulmonary Embolism or Deep Vein Thrombosis but restricted our analysis only to TKR. We intended to capture cases of postoperative venous thromboses and embolism - specifically, pulmonary embolism and deep venous thrombosis. For our analysis we separated TKR into 2 groups; one without DVT/PE and the other with DVT/PE. We analyzed all surgical discharges age 18 years and older with an ICD-9-CM code for an operating room procedure TKR (ICD-9 8154). From this we excluded those who have principal diagnosis of DVT/PE, as these patients are likely to have had PE/DVT present on admission and not because of TKR and also where a procedure for interruption of vena cava (IVC filter) (ICD-9 387) occurs before or on the same day as the first operating room procedure as these patients likely had DVT/PE even before TKR. We then created a subset from the first group, with discharges ICD-9-CM codes for deep vein thrombosis or pulmonary embolism in any secondary diagnosis field and thus defined the group of patients who developed DVT/PE after TKR. We used the following ICD-9 codes to represent DVT (ICD-9 codes 451.11, 451.19, 451.2, 451.81, 451.9, 453.40, 453.41, 453.42, 453.8, 453.9) and PE (ICD-9 codes 415.1–415.19). IBM SPSS Statistics 18 was used for data mining and analysis. Result: In the year 2007, there were 550,770 discharges with a procedure for TKR. After excluding primary diagnosis of DVT/PE and IVC filter, we had 550228 as our working number. Of these, 5454 discharges had a secondary diagnosis of DVT/PE (Rate - 10 new cases per 1000 TKR procedures). Demographics and health care utilization between those who did or did not develop are described in Table 1. Co-morbidities associated with those who did or did not develop DVT are described in (Table 2). Conclusion: DVT & PE are major avoidable complications of Total Knee replacement and are associated with significant mortality and health care costs. These data demonstrate that there may not be any significant differences in age and associated co-morbidities between those who do or do not develop DVT/PE following total knee replacement except for UTI which can be attributed to the difference in length of stay. The absence of serious co-morbidities like AF and CHF in both groups suggest those with serious co-morbidities may not be receiving total knee replacement. That no differences were noticed in associated co-morbidities among those who did or did not develop DVT/PE following TKR provide the rationale for further study of factors contributing to this serious complication of TKR. Such studies may inform future strategies for prevention of post-operative DVT/PE. Disclosure: No relevant conflicts of interest to declare.

Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting

The Lancet ◽  
2006 ◽  
Vol 367 (9516) ◽  
pp. 1075-1079 ◽  
Author(s):  
Liam Smeeth ◽  
Claire Cook ◽  
Sara Thomas ◽  
Andrew J Hall ◽  
Richard Hubbard ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Acute Infection ◽  
Community Setting ◽  
Vein Thrombosis ◽  
Deep Vein

Incidence of venous thromboembolism among patients receiving neoadjuvant chemotherapy for advanced epithelial ovarian cancer

2020 ◽  
Vol 30 (4) ◽  
pp. 491-497 ◽  
Author(s):  
Julia Rose Salinaro ◽  
Kourtnie McQuillen ◽  
Megan Stemple ◽  
Robert Boccaccio ◽  
Jessie Ehrisman ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Primary Outcome ◽  
Vein Thrombosis ◽  
Deep Vein

ObjectivesNeoadjuvant chemotherapy may be considered for women with epithelial ovarian cancer who have poor performance status or a disease burden not amenable to primary cytoreductive surgery. Overlap exists between indications for neoadjuvant chemotherapy and known risk factors for venous thromboembolism, including impaired mobility, increasing age, and advanced malignancy. The objective of this study was to determine the rate of venous thromboembolism among women receiving neoadjuvant chemotherapy for epithelial ovarian cancer.MethodsA multi-institutional, observational study of patients receiving neoadjuvant chemotherapy for primary epithelial ovarian, fallopian tube, or peritoneal cancer was conducted. Primary outcome was rate of venous thromboembolism during neoadjuvant chemotherapy. Secondary outcomes included rates of venous thromboembolism at other stages of treatment (diagnosis, following interval debulking surgery, during adjuvant chemotherapy, or during treatment for recurrence) and associations between occurrence of venous thromboembolism during neoadjuvant chemotherapy, subject characteristics, and interval debulking outcomes. Venous thromboembolism was defined as deep vein thrombosis in the upper or lower extremities or in association with peripherally inserted central catheters or ports, pulmonary embolism, or concurrent deep vein thrombosis and pulmonary embolism. Both symptomatic and asymptomatic venous thromboembolism were reported.ResultsA total of 230 patients receiving neoadjuvant chemotherapy were included; 63 (27%) patients overall experienced a venous thromboembolism. The primary outcome of venous thromboembolism during neoadjuvant chemotherapy occurred in 16 (7.7%) patients. Of the remaining venous thromboembolism events, 22 were at diagnosis (9.6%), six post-operatively (3%), five during adjuvant chemotherapy (3%), and 14 during treatment for recurrence (12%). Patients experiencing a venous thromboembolism during neoadjuvant chemotherapy had a longer mean time to interval debulking and were less likely to undergo optimal cytoreduction (50% vs 80.2%, p=0.02).ConclusionsPatients with advanced ovarian cancer are at high risk for venous thromboembolism while receiving neoadjuvant chemotherapy. Consideration of thromboprophylaxis may be warranted.

P6461The long-term clinical comparisons of symptomatic patients of pulmonary embolism with and those without deep vein thrombosis: from the COMMAND VTE Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Murata ◽  
Y Yamashita ◽  
T Morimoto ◽  
H Amano ◽  
T Takase ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Acute Phase ◽  
Clinical Presentation ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
Severe Clinical Presentation ◽  
Recurrent Vte ◽  
Deep Vein

Abstract Background Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), has significant morbidity and mortality. Acute PE, in particular, is fatal if we miss it, and symptomatic patients of PE sometimes have concomitant DVT. Purpose This study compared the risk of mortality in symptomatic patients of PE with and those without DVT in the long term. Methods The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. Patients with both PE and DVT (N=1334) were regarded as PE patients, and the current study population consisted of 1715 PE patients and 1312 DVT patients. Results There were 1203 symptomatic patients of PE, including 381 without and 822 with DVT. In our cohort, the mean age was 67.9±14.9 years, 63% was female, 44% had hypertension, 12% diabetes mellitus, 5% history of VTE. There were 20% of active cancer. Baseline characteristics were well matched except for dyslipidemia (18% vs. 23%, p=0.021) and atrial fibrillation (8% vs. 5%, p=0.045). Patients without DVT had a more severe clinical presentation compared to those with DVT, including hypoxemia, shock and arrest. Moreover, Initial parenteral anticoagulation therapy in the acute phase was administered less frequently in patients without DVT (89% vs. 96%, P=0.0001). Two groups received thrombolysis (20% vs. 26%, P=0.18) and mechanical supports (Ventilator 14% vs. 5%, p<0.001, PCPS 5% vs. 3%, p<0.001, respectively). During follow-up, 93 (8%) patients experienced recurrent VTE events and 98 (8%) major bleeding events, and 323 (27%) patients died. The most frequent cause of death was cancer (11%). There were a significant differences in the cumulative incidences of all-cause death between the groups (32% vs. 24%, P=0.006), whereas there was significant difference in VTE-related death (13% vs. 4%, p<0.001). Estimated freedom rates from death for patients of PE without and those with DVT were as follows: 88% vs 99% at 10-day, 86% vs 95% at 1-month, 75% vs 83% at 1-year, and 64% vs 71% at 5-year, respectively. Landmark analysis Conclusions In symptomatic patients of PE, there was a difference in mortality between groups, but no difference in recurrent VTE. Patients without DVT had a more severe clinical presentation compared to those with DVT, and many VTE-related deaths in the acute phase. The one-month mortality rate differed statistically between groups, but there was no significant difference in long-term survival beyond one month. Most of deaths were due to underlying diseases, mainly cancer, and less commonly due to VTE in the long term. Acknowledgement/Funding Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

Sign in / Sign up

Export Citation Format

Share Document