Incidence of Deep Vein Thrombosis in Hospitalized Chinese Medical Patients and the Impact of DVT Prophylaxis

Objective. To evaluate the incidence of deep vein thrombosis in hospitalized Chinese medical patients and the impact of DVT prophylaxis. Methods. All cases of confirmed proximal DVT from 1 January 2005 to 31 December 2008 were reviewed retrospectively to determine the presence of risk factors and whether DVT developed: during hospitalization in medical wards or in case of readmission with a diagnosis of DVT within 14 days of discharge from a recent admission to medical wards. The impact of prophylaxis will be estimated by comparing the annual incidence of proximal DVT among medical patients hospitalized from 2005 to 2007 with that of 2008 (DVT prophylaxis commonly used). Results. From 1 January 2005 to 31 December 2008, 3938 Doppler ultrasound studies were performed for suspected DVT. Proximal DVT was diagnosed in 687 patients. The calculated incidence of proximal DVT among medical patients hospitalized for at least two days was , , and for the year 2005, 2006, and 2007, respectively. The incidence was for 2008 (). Conclusion. Proximal DVT was substantial in Chinese medical patients, and DVT prophylaxis might reduce such risk.

Download Full-text

Which hospitalized medical patients need deep vein thrombosis (DVT) prophylaxis?

Evidence-Based Practice ◽

10.1097/01.ebp.0000541182.40356.43 ◽

2016 ◽

Vol 19 (3) ◽

pp. E-3

Author(s):

Ho Phong Pham ◽

Dausen Harker

Keyword(s):

Deep Vein Thrombosis ◽

Medical Patients ◽

Vein Thrombosis ◽

Dvt Prophylaxis ◽

Deep Vein

Download Full-text

A Simple Way to Improve DVT Protocol Compliance

Phlebology The Journal of Venous Disease ◽

10.1177/026835550201600308 ◽

2002 ◽

Vol 16 (3) ◽

pp. 121-124 ◽

Cited By ~ 2

Author(s):

M. E. Birks ◽

S. Aiono ◽

T. R. Magee ◽

R. B. Galland

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Low Dose ◽

District General Hospital ◽

Vein Thrombosis ◽

The United Kingdom ◽

Raising Awareness ◽

Protocol Compliance ◽

Deep Vein ◽

The Impact

Objective: To assess the impact on deep vein thrombosis (DVT) protocol violations of the introduction of a label attached to the patient's drug chart, which specifically allows low-dose subcutaneous heparin or thromboembolic deterrent stockings (TEDS) to be prescribed as appropriate. Design: An audit study. Setting: Department of General Surgery of a District General Hospital in the United Kingdom. Method: All adult general surgical inpatients on a Weekday were studied. Staff were not forewarned of the studies. Patient details and risk factors for DVT were noted. Details of administered DVT prophylaxis were recorded. In total four separate studies were undertaken, namely: with original protocols (I), with refined protocol 1 and 3 years later (II, III) and finally after introduction of the label (IV). Results: Protocol violations were defined as being ‘acceptable’ or ‘unacceptable’. Raising awareness between studies I and II reduced acceptable violations to zero. There was no statistically significant reduction in unacceptable violations (24 in 80 patients, 1; 17 in 75, II; 13 in 60, III). In study IV, following introduction of the label, there were only 6 violations in 51 patients ( p<0.02). Conclusion: Combining increased awareness with the attachment of a label to the drug chart reduced unacceptable violations by 63%.

Download Full-text

DVT Prophylaxis in the Perioperative Setting

British Journal of Perioperative Nursing (United Kingdom) ◽

10.1177/175045890201200902 ◽

2002 ◽

Vol 12 (9) ◽

pp. 326-331 ◽

Cited By ~ 2

Author(s):

Agnes Arnold

Keyword(s):

Deep Vein Thrombosis ◽

Endothelial Damage ◽

Venous Stasis ◽

Vein Thrombosis ◽

Dvt Prophylaxis ◽

Deep Vein ◽

The Impact

In last month's BJPN, Agnes Arnold discussed the pathophysiology of deep vein thrombosis and suggested ways that the risk could be reduced, particularly with respect to DVTs resulting from endothelial damage in surgery. In this, the second of a two-part series, Agnes continues by looking at hypercoagulability of blood and venous stasis and the impact of these conditions on the risk of DVT.

Download Full-text

The profile and frequency of known risk factors or comorbidities for deep vein thrombosis in an urban district hospital in KwaZulu-Natal

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v17i1.425 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 4

Author(s):

Damilola Awolesi ◽

Mergan Naidoo ◽

Mohammed H. Cassimijee

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

District Hospital ◽

Health Impact ◽

Young Female ◽

Medical Patients ◽

Urban District ◽

Vein Thrombosis ◽

Hospitalised Patients ◽

Deep Vein

Background: Although deep vein thrombosis (DVT) is a preventable disease, it increases the morbidity and mortality in hospitalised, patients, resulting in considerable economic health impact. The identification and primary prevention of risk factors using risk assessment and stratification with subsequent anti-thrombotic prophylaxis in moderate- to severe-risk categories is the most rational means of reducing morbidity and mortality.Aim and setting: The aim of the study was to describe the profile and frequency of known risk factors or comorbidities of hospitalised medical patients with ultrasound-diagnosed DVT in an urban district hospital in KwaZulu-Natal.Methods: A retrospective review of clinical notes of all medical patients (age ≥ 13 years) admitted to the hospital with ultrasound-diagnosed DVT between July and December 2013.Results: The median age was 40 years (interquartile range 32–60 years) and female preponderance was 72.84%. HIV and tuberculosis emerged as the prevalent risk factors, accounting for 51.85% and 35.80%, respectively. Other risk factors observed were recent hospitalisation (34.57%), smoking (25.93%), previous DVT (19.75%) and congestive cardiac failure (18.52%).Conclusion: DVT in our study occurred predominantly in young female patients unlike previous studies where patients were generally older. Furthermore, HIV and tuberculosis were the two most common known risk factors or comorbidities observed. Clinicians should have a heightened awareness of venous thromboembolism in patients with either condition or where both conditions occur together and appropriate thromboprophylaxis should be administered.Keywords: Deep Vein Thrombosis; risk factors; profile

Download Full-text

Recurrence Risk after First Symptomatic Distal versus Proximal Deep Vein Thrombosis According to Baseline Risk Factors

TH Open ◽

10.1055/s-0039-1683374 ◽

2019 ◽

Vol 03 (01) ◽

pp. e58-e63 ◽

Cited By ~ 4

Author(s):

Luca Valerio ◽

Chiara Ambaglio ◽

Marisa Barone ◽

Mariella Ciola ◽

Stavros Konstantinides ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Deep Vein Thrombosis ◽

Baseline Risk ◽

Prognostic Impact ◽

Risk Of Recurrence ◽

Vein Thrombosis ◽

Recurrent Vte ◽

Deep Vein ◽

The Impact

Background It remains unclear whether the distal location of deep vein thrombosis (DVT) is independently associated with a lower risk of recurrence in all patients, or represents a marker of the presence and severity of provoking factors for venous thromboembolism (VTE). Methods We investigated the impact of distal (vs. proximal) DVT location on the risk of developing symptomatic, objectively confirmed recurrent VTE in 831 patients with a first acute symptomatic DVT not associated with pulmonary embolism (PE), who were stratified by the presence of transient or persistent risk factors at baseline. The primary outcome was symptomatic, objectively diagnosed recurrent VTE, including proximal DVT and PE. Results A total of 205 (24.7%) patients presented with a transient risk factor, 189 (22.7%) with a minor persistent risk factor, 202 (24.3%) with unprovoked DVT, and 235 (28.3%) with cancer-associated DVT. One-hundred twenty-five patients (15.0%) experienced recurrent DVT or PE. The largest relative difference between patients with distal (vs. proximal) DVT was observed in the absence of identifiable risk factors (adjusted hazard ratio [aHR]: 0.11; 95% CI [confidence interval]: 0.03–0.45). In patients with cancer, distal and proximal DVT had a comparable risk of recurrence (aHR: 0.70; 95% CI: 0.28–1.78]). Conclusions The distal (vs. proximal) location of first acute symptomatic DVT represented, in the absence of any identifiable transient or persistent risk factors, a favorable prognostic factor for recurrence. In contrast, the prognostic impact of DVT location was weaker if persistent provoking risk factors for VTE were present, notably cancer.

Download Full-text

Incidence, Natural History and Risk Factors of Deep Vein Thrombosis in Elective Knee Arthroscopy

Thrombosis and Haemostasis ◽

10.1055/s-0037-1616137 ◽

2001 ◽

Vol 86 (09) ◽

pp. 817-821 ◽

Cited By ~ 67

Author(s):

N. Hunt ◽

R. K. Strachan ◽

A. N. Nicolaides ◽

K. T. Delis

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Relative Risk ◽

Early Diagnosis ◽

Knee Arthroscopy ◽

Clot Lysis ◽

Compression Stockings ◽

Vein Thrombosis ◽

Deep Vein ◽

The Impact

Summary Aims: to determine the incidence, anatomical distribution and extent of deep vein thrombosis (DVT) in limbs undergoing elective unilateral knee arthroscopy without active prophylaxis, to evaluate its effect on venous function following early diagnosis, and to quantify the impact of risk factors on its incidence. Methods: 102 consecutive patients undergoing unilateral knee arthroscopy without prophylaxis were studied. A history was obtained with emphasis on the risk factors for thromboembolism, and physical examination and colour duplex were performed prior to and within a week after surgery. Patients who developed calf DVT were given aspirin (150 mg) and compression stockings; those with proximal DVT were admitted for anticoagulation (heparin followed by warfarin). Follow-up (mean 118 [range 84-168] days) entailed weekly physical and duplex examinations during the first month and monthly thereafter. Results: 8 patients developed calf DVT in the operated leg (incidence 7.84% [95% Cl: 2.7%-13.2%]); thrombosis was asymptomatic in 4 of those (50%), caused calf tenderness in 4 (50%) and a positive Homan’s sign in one (12.5%). DVT occurred in the following veins: peroneal 4 subjects (50%), soleal 4 (50%), gastrocnemial 2 (25%) and tibial 2 (25%). Propagation of a calf DVT to the popliteal vein was identified in 1 patient (12.5%). After a median period of 118 days, total clot lysis was found in 50% of DVTs, with partial thrombus resorption in the rest; reflux in the thrombosed veins was present in 75% of limbs with DVT. 43% of patients had 1 risk factor for DVT and 20% had ≥2. The incidence of DVT was higher amongst those with two or more risk factors for thromboembolism (p <.05) or those with previous thrombosis alone (p <.005). Symptoms or signs of pulmonary embolism were not documented. Conclusions: Elective unilateral knee arthroscopy performed without prophylaxis is complicated by ipsilateral calf DVT in 7.8% (95% CI: 2.7%-13.2%) of cases. The risk is higher in the presence of previous thrombosis (relative risk: 8.2) and two or more risk factors for DVT (relative risk: 2.94). Thrombosis may propagate to the proximal veins, despite early diagnosis. 50% of calf clots totally lyse in 4 months, yet reflux develops in at least 75% of limbs with DVT. Further studies to determine optimal prophylaxis are warranted.

Download Full-text

Role of age, sex, and specific provoking factors on the distal versus proximal presentation of first symptomatic deep vein thrombosis: analysis of the SWIss Venous ThromboEmbolism Registry (SWIVTER)

Internal and Emergency Medicine ◽

10.1007/s11739-021-02878-7 ◽

2021 ◽

Author(s):

David Spirk ◽

Tim Sebastian ◽

Jürg Hans Beer ◽

Lucia Mazzolai ◽

Drahomir Aujesky ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Acute Infection ◽

Multivariable Analysis ◽

Lower Limbs ◽

Vein Thrombosis ◽

Male Sex ◽

Deep Vein ◽

The Impact

AbstractWe aimed to evaluate the impact of age, sex, and their interactions with provoking risk factors for deep vein thrombosis (DVT). In addition, we intended to provide additional insights on risk factors associated with the isolated distal versus proximal presentation of first symptomatic acute DVT, both being characterized by different prognosis. In the present analysis from the SWIss Venous ThromboEmbolism Registry (SWIVTER), we compared demographic and baseline characteristics in patients with isolated distal (n = 184; 35%) versus proximal (n = 346) DVT of the lower limbs without symptomatic pulmonary embolism, and identified factors related with the presenting thrombosis location. In the overall population, mean age was 59 ± 19 years, 266 (50%) were women, 106 (20%) patients had cancer, 86 (16%) recent surgery, and 52 (10%) acute infection/sepsis. In a multivariable analysis, recent surgery [odds ratio (OR) 2.92, 95% confidence interval (CI) 1.80–4.73] was independently associated with a diagnosis of isolated distal DVT, whereas cancer (OR 2.01, 95% CI 1.20–3.35), male sex aged 41 to 75 years (OR 2.21, 95% CI 1.33–3.67), and acute infection/sepsis (OR 2.71, 95% CI 1.29–5.66) with a diagnosis of proximal DVT. In SWIVTER, age, sex, and several provoking risk factors for VTE appeared to be related with the presenting location of first symptomatic DVT. Cancer, male sex, and acute infection/sepsis were associated with a proximal location of DVT, whereas recent surgery was associated with a distal presentation, likely acting as confounders for the association between thrombosis location and prognosis.

Download Full-text

Is Colour Doppler Ultrasound a Sensitive Screening Method in Diagnosing Deep Vein Thrombosis after Hip Surgery ?

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650252 ◽

1996 ◽

Vol 75 (02) ◽

pp. 242-245 ◽

Cited By ~ 20

Author(s):

Marie Magnusson ◽

Bengt I Eriksson ◽

Peter Kãlebo ◽

Ramon Sivertsson

Keyword(s):

Deep Vein Thrombosis ◽

High Risk ◽

Doppler Ultrasound ◽

Predictive Value ◽

Screening Method ◽

Colour Doppler ◽

Vein Thrombosis ◽

Colour Doppler Ultrasound ◽

Asymptomatic Patients ◽

Deep Vein

SummaryPatients undergoing orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively.CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. The overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.

Download Full-text

Diagnosis of Deep Vein Thrombosis by Combination of Doppler Ultrasound Flow Examination and Strain Gauge Plethysmography

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657149 ◽

1982 ◽

Vol 47 (02) ◽

pp. 141-144 ◽

Cited By ~ 7

Author(s):

H Bounameaux ◽

B Krähenbühl ◽

S Vukanovic

Keyword(s):

Deep Vein Thrombosis ◽

Negative Predictive Value ◽

Doppler Ultrasound ◽

Strain Gauge ◽

Predictive Value ◽

Lower Limbs ◽

Vein Thrombosis ◽

Non Invasive ◽

Strain Gauge Plethysmography ◽

Deep Vein

SummaryDoppler ultrasound flow examination, strain gauge plethysmography and contrast venography were performed in 160 lower limbs of 80 in-patients. Deep vein thrombosis (DVT) was suspected in 87 limbs. Using measurement of venous stop-flow pressure, the Doppler method had an overall sensitivity of 83%. By combined use of Doppler and Plethysmography, sensitivity was increased to 96%. Specificity was 62% and 51%, respectively. With a positive and a negative predictive value of 80% and 73%, respectively, the combination of both non-invasive methods cannot reliably replace venography in the diagnosis of DTV, although all (40/40) thromboses proximal to or involving the popliteal segment were detected by either Doppler and Plethysmography or both.After exclusion of 14 patients (18%) suffering from conditions known to alter the results of these non-invasive methods, the positive predictive value of abnormal findings in both Doppler and Plethysmography was increased to 94% for suspected limbs, whilst negative predictive value of both negative Doppler and Plethysmography was 90%, allowing the avoidance of venography in these patients.

Download Full-text