Accuracy of complete compression ultrasound in ruling out suspected deep venous thrombosis in the ambulatory setting

2009 ◽  
Vol 102 (07) ◽  
pp. 166-172 ◽  
Author(s):  
Marie-Antoinette Sevestre ◽  
Pierre Casez ◽  
Luc Bressollette ◽  
Mébarka Taiar ◽  
Gilles Pernod ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Anticoagulant Therapy ◽  
Thromboembolic Events ◽  
Office Setting ◽  
Compression Ultrasound ◽  
Venous Thromboembolic Events ◽  
Ambulatory Patients ◽  
Venous Thromboembolic

SummaryEvidence on the safety of complete compression ultrasound for ruling out deep venous thrombosis (DVT) is derived from studies conducted in tertiary care centers, although most patients with suspected DVT are managed in the ambulatory office setting. It was the objective of this study to estimate the rate of venous thromboembolism when anticoagulant therapy is withheld from ambulatory patients with normal findings on a single complete compression ultrasound. As part of a prospective cohort study, 3,871 ambulatory patients with clinically suspected DVT were enrolled by 255 board-certified vascular medicine physicians practicing in private offices in France. Compression ultrasound of the entire lower extremities was performed using a standardised examination protocol. Anticoagulant therapy was withheld from patients with negative findings on compression ultrasound, and 1,254 of them were randomly selected for follow-up. The main outcome measure was the three-month incidence of symptomatic venous thromboembolic events confirmed by objective testing. DVT was detected in 1,023 patients (26.4%),including 454 (11.7%) and 569 (14.7%) cases of proximal and isolated distal DVT, respectively. Of the 1,254 patients with negative results sampled for follow-up, six received anticoagulant therapy during follow-up and five were lost to follow-up. Five of 1,243 patients (0.4%, 95% confidence interval [CI], 0.1–0.9) experienced non-fatal symptomatic venous thromboembolic events (pulmonary embolism in two patients and DVT in three patients) and eight of 1,254 patients (0.6%, 95% CI, 0.3–1.2) died during the three-month follow-up. In conclusion, anticoagulant therapy can be safely withheld after negative complete compression ultrasound without further testing in the ambulatory office setting.

Effects of the Timing and the Type of Venous Thromboembolic Events On Survival in Patients with Pancreatic Cancer

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1151-1151
Author(s):  
Vivek Kesari ◽  
Maithili Shethia ◽  
Xiao Zhou ◽  
Michael Overman ◽  
Saroj Vadhan-Raj
Keyword(s):  
Pancreatic Cancer ◽  
Survival Analysis ◽  
Cancer Diagnosis ◽  
Thromboembolic Events ◽  
Kaplan Meier ◽  
Compression Ultrasound ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
The Impact

Abstract Abstract 1151 Background: Patients (pts) with pancreatic cancer are at high risk for venous thromboembolic events (VTE) and the occurrence of VTE can adversely affect prognosis. However, it is unclear if the type of VTE such as symptomatic vs incidental, deep vein thrombosis (DVT) vs pulmonary embolism (PE), the location of VTE [DVT of extremities vs visceral veins (abdominal/pelvic veins)] or the timing of VTE from diagnosis can influence the survival. The purpose of this study was to evaluate the incidence of different types of VTE, the impact of types and timing of VTE (early vs late) on survival. Methods: Medical records of 260 pts with pancreatic cancer, newly referred to MDACC in 2006, were reviewed for cancer diagnosis, patient demographics (age, gender), presence of metastasis, the date of diagnosis of VTE, timing of VTE, type of VTE, the site of VTE, the incidence of VTE during 2 years of follow up from the date of diagnosis. Clinical and laboratory parameters predictive for survival were also reviewed. All VTE episodes, including symptomatic as well as incidental VTEs were confirmed by the radiological studies using CT ANGIO, CT scan, Doppler compression ultrasound or V/Q perfusion scans. The survival time was calculated from the date of cancer diagnosis to the date of last follow up. Survival analysis was conducted using Kaplan-Meier method and Cox proportional hazard models. The stepwise selection method was employed to build a multivariate model using variables with p<0.15 in univariate analysis. Results: Of the 260 pts referred, 235 were confirmed to have the diagnosis of pancreatic carcinoma. During the 2-year follow-up, 80 pts (34%) had 109 episodes of VTE, including symptomatic and incidental episodes. The median age of the pts with VTE was 59 years (range: 28–86) and 51% were males. Of the 80 pts with VTE, 21 (26%) had PE, 18 (23%) had DVT of extremities, 28 (35%) had DVT of visceral veins and 13 (16%) had concurrent PE/DVT (diagnosed on the same day). Of the 80 pts, 25 (31%) had 29 recurrent episodes. Kaplan-Meier survival analysis, as shown in the table below, indicated that the pts who had early VTE (defined as VTE diagnosed within 30 days from the date of diagnosis of pancreatic cancer) vs late VTE (> 30 days) and pts with metastasis vs no metastasis had statistically poor 1 year survival (log-rank test). Conclusions: These findings suggest that timing of VTE is an important indicator of prognosis, regardless of whether symptomatic or incidental. Patients with VTE within 30 days of diagnosis have shorter survival. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Early chemoprophylaxis for deep venous thrombosis does not increase the risk of hematoma expansion in patients presenting with spontaneous intracerebral hemorrhage

2021 ◽  
Vol 12 ◽  
pp. 277
Author(s):  
Dimitri Laurent ◽  
Olgert Bardhi ◽  
Paul Kubilis ◽  
Brian Corliss ◽  
Stephanie Adamczak ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Hematoma Expansion ◽  
Optimal Timing ◽  
Thromboembolic Events ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Background: Spontaneous intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. The development of venous thromboembolism (VTE), including deep venous thrombosis or pulmonary embolism, is correlated with negative outcomes following ICH. Due to the risk of hematoma expansion associated with the use of VTE chemoprophylaxis, there remains significant debate about the optimal timing for its initiation following ICH. We analyzed the risk of early chemoprophylaxis on hematoma expansion following ICH. Methods: We performed a retrospective analysis of patients presenting with spontaneous ICH at single institution between 2011 and 2018. The rate of hematoma expansion was compared between patients that received early chemoprophylaxis (on admission) and those that received conventional chemoprophylaxis (>24 h). Results: Data for 235 patients were available for analysis. Eleven patients (7.5%) in the early prophylaxis cohort and seven patients (8.0%) in the conventional prophylaxis cohort developed VTE (P = 0.9). Hematoma expansion also did not differ significantly (early 19%, conventional 23%, P = 0.5). Conclusion: The use of early chemoprophylaxis against venous thromboembolic events following ICH appears safe in our patient population without increasing the risk of hematoma expansion. Given the increased risk of poor outcome in the setting of VTE, early VTE chemoprophylaxis should be considered in patients who present with ICH. Larger, prospective, and randomized studies are necessary to better elucidate the risk of early chemoprophylaxis and potential reduction in venous thromboembolic events.

scholarly journals Risk of Venous Thromboembolic Events in Patients with Osteonecrosis of the Femoral Head Undergoing Primary Hip Arthroplasty

2019 ◽  
Vol 8 (12) ◽  
pp. 2158
Author(s):  
Pei-Hsun Sung ◽  
Yao-Hsu Yang ◽  
Hsin-Ju Chiang ◽  
John Y. Chiang ◽  
Hon-Kan Yip ◽  
...  
Keyword(s):  
Femoral Head ◽  
Hip Arthroplasty ◽  
Hip Replacement ◽  
Thromboembolic Events ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Post Surgery ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Previous data have shown patients with osteonecrosis of the femoral head (ONFH) have increased lifelong risk of unprovoked venous thromboembolic events (VTE) as compared with the general population, according to sharing common pathological mechanism of endothelial dysfunction. However, whether the risk of VTE increases in those ONFH patients undergoing major hip replacement surgery remains unclear. This is a retrospective nationwide Asian population-based study. From 1997 to 2013, a total of 12,232 ONFH patients receiving partial or total hip replacement for the first time and revision surgeries were retrospectively selected from Taiwan Health Insurance surgical files. By 1:1 matching on age, sex, surgical types, and socioeconomic status, 12,232 subjects without ONFH undergoing similar hip surgery were selected as non-ONFH group. The incidence and risk of post-surgery VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE), were compared between the ONFH and non-ONFH groups. Results showed that 53.8% of ONFH patients were male and the median age was 61.9 years old. During the mean follow-up period of 6.4 years, the incidences of VTE (1.4% vs. 1.2%), DVT (1.1% vs. 0.9%), and PE (0.4% vs. 0.4%) were slightly but insignificantly higher in the ONFH than in the non-ONFH group undergoing the same types of major hip replacement surgery (all p-values > 0.250). Concordantly, we found no evidence that the risk of VTE was increased in the ONFH patients as compared with the non-ONFH counterparts (adjusted HR 1.14; 95% CI 0.91–1.42; p = 0.262). There were also no increased risks for DVT and PE in the ONFH subgroups stratified by comorbidities, drug exposure to pain-killer or steroid, and follow-up duration after surgery, either. In conclusion, hip arthroplasty in Asian patients with ONFH is associated with similar rates of VTE as compared to patients with non-ONFH diagnoses.

scholarly journals Arterial events, venous thromboembolism, thrombocytopenia, and bleeding after vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: population based cohort study

BMJ ◽  
2021 ◽  
pp. n1114 ◽  
Author(s):  
Anton Pottegård ◽  
Lars Christian Lund ◽  
Øystein Karlstad ◽  
Jesper Dahl ◽  
Morten Andersen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Population Based ◽  
Thromboembolic Events ◽  
Coagulation Disorders ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
General Populations

Abstract Objective To assess rates of cardiovascular and haemostatic events in the first 28 days after vaccination with the Oxford-AstraZeneca vaccine ChAdOx1-S in Denmark and Norway and to compare them with rates observed in the general populations. Design Population based cohort study. Setting Nationwide healthcare registers in Denmark and Norway. Participants All people aged 18-65 years who received a first vaccination with ChAdOx1-S from 9 February 2021 to 11 March 2021. The general populations of Denmark (2016-18) and Norway (2018-19) served as comparator cohorts. Main outcome measures Observed 28 day rates of hospital contacts for incident arterial events, venous thromboembolism, thrombocytopenia/coagulation disorders, and bleeding among vaccinated people compared with expected rates, based on national age and sex specific background rates from the general populations of the two countries. Results The vaccinated cohorts comprised 148 792 people in Denmark (median age 45 years, 80% women) and 132 472 in Norway (median age 44 years, 78% women), who received their first dose of ChAdOx1-S. Among 281 264 people who received ChAdOx1-S, the standardised morbidity ratio for arterial events was 0.97 (95% confidence interval 0.77 to 1.20). 59 venous thromboembolic events were observed in the vaccinated cohort compared with 30 expected based on the incidence rates in the general population, corresponding to a standardised morbidity ratio of 1.97 (1.50 to 2.54) and 11 (5.6 to 17.0) excess events per 100 000 vaccinations. A higher than expected rate of cerebral venous thrombosis was observed: standardised morbidity ratio 20.25 (8.14 to 41.73); an excess of 2.5 (0.9 to 5.2) events per 100 000 vaccinations. The standardised morbidity ratio for any thrombocytopenia/coagulation disorders was 1.52 (0.97 to 2.25) and for any bleeding was 1.23 (0.97 to 1.55). 15 deaths were observed in the vaccine cohort compared with 44 expected. Conclusions Among recipients of ChAdOx1-S, increased rates of venous thromboembolic events, including cerebral venous thrombosis, were observed. For the remaining safety outcomes, results were largely reassuring, with slightly higher rates of thrombocytopenia/coagulation disorders and bleeding, which could be influenced by increased surveillance of vaccine recipients. The absolute risks of venous thromboembolic events were, however, small, and the findings should be interpreted in the light of the proven beneficial effects of the vaccine, the context of the given country, and the limitations to the generalisability of the study findings.

scholarly journals Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Christine Hohl Moinat ◽  
Daniel Périard ◽  
Adrienne Grueber ◽  
Daniel Hayoz ◽  
Jean-Luc Magnin ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Venous Thrombosis ◽  
Cancer Patients ◽  
Thromboembolic Events ◽  
Central Venous ◽  
Central Venous Port ◽  
Venous Port ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Insertion of central venous port (CVP) catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE). However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE), or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3%) at 3 months, and 11.3% (IC95 9.4–13.2%) at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3%) at 3 months, and 15.3% (IC95 13.1–17.6%) at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis.

scholarly journals Zika and Chikungunya Virus and Risk for Venous Thromboembolism

2019 ◽  
Vol 25 ◽  
pp. 107602961882118 ◽  
Author(s):  
Eduardo Ramacciotti ◽  
Leandro B. Agati ◽  
Valéria C. R. Aguiar ◽  
Nelson Wolosker ◽  
João C. Guerra ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Viral Infections ◽  
University Hospital ◽  
Endemic Region ◽  
Venous Thromboembolic Events ◽  
Hospital Patients ◽  
Venous Thromboembolic ◽  
D Dimer

A variety of viral infections are associated with hypercoagulable states and may be linked to the development of deep venous thrombosis and pulmonary embolism. The Zika and Chikungunya viral infections spread through the South and Central American continents, moving to North America in 2016, with severe cases of polyarthralgia, fever, and Guillain-Barré syndrome leading eventually to death. A decreased trend for both infections was reported in the first quarter of 2017. In this article, we report the possible association of venous thromboembolic events associated with Zika infection. After 2 cases of deep venous thrombosis in patients with acute Zika infections, D-dimer levels were measured in 172 consecutive patients who presented to the emergency department of a university hospital in an endemic region of Brazil with either Zika or Chikungunya infections confirmed by polymerase chain reaction tests. D-dimer levels were increased in 19.4% of 31 patients with Zika and in 63.8% of 141 patients with Chikungunya infections. The mechanisms behind this association are yet to be elucidated as well as the potential for venous thromboembolism prevention strategies for in-hospital patients affected by Zika and Chikungunya infections.

scholarly journals High prevalence of deep venous thrombosis in non-severe COVID-19 patients hospitalized for a neurovascular disease

2020 ◽  
Author(s):  
Olivier Rouyer ◽  
Irene-Nora Pierre-Paul ◽  
Amadou Balde ◽  
Damaris Jupitet ◽  
Daniela Bindila ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Haemorrhagic Stroke ◽  
Lower Limbs ◽  
Symptomatic Pulmonary Embolism ◽  
Venous Thromboembolic Events ◽  
High Prevalence ◽  
Venous Thromboembolic ◽  
Ischemic Attack ◽  
Neurovascular Diseases

Abstract Introduction: Severe SARS-CoV-2 infection, responsible for COVID-19, is accompanied by venous thromboembolic events particularly in intensive care unit. In non-severe COVID-19 patients affected by neurovascular diseases, the prevalence of deep venous thrombosis (DVT) is unknown. The aim of or study was to report data obtained after systematic Doppler ultrasound scanning (DUS) of lower limbs in such patients. Methods: Between March 20 and May 2, 2020, consecutive patients with neurovascular diseases with non-severe COVID-19 were investigated with a systematic bedside DUS. Results Thirteen patients were enrolled including 10 acute ischemic strokes, one transient ischemic attack, one cerebral venous thrombosis and one haemorrhagic stroke. At admission, the median National Institute of Health Stroke Scale (NIHSS) was of 6 (IQR, 0-20). We found a prevalence of 38.5% of asymptomatic calves DVT (n=5) during the first week after admission despite thromboprophylaxis. Among them, one patient had a symptomatic pulmonary embolism. Two patients died during hospitalization but the outcome was favourable in the others with a discharge median NIHSS of 1 (IQR, 0-11). Discussion/Conclusion: Despite thromboprophylaxis, systematic bedside DUS showed a high prevalence of 38.5% of DVT in non-severe COVID-19 patients with neurovascular diseases. Therefore, we suggest that this non-invasive investigation should be performed in all patients of this category.

Follow-up after deep venous thrombosis in azygos continuation

VASA ◽  
2005 ◽  
Vol 34 (4) ◽  
pp. 266-268
Author(s):  
Mouton ◽  
Zehnder ◽  
Wagner ◽  
Mouton
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Thrombosis Prophylaxis ◽  
Collateral Flow ◽  
Thromboembolic Events ◽  
Azygos Continuation ◽  
Venous Claudication

Background: To determine the sequelae of patients after deep venous thrombosis in patients with azygos continuation defined as agenesis of the inferior vena cava with collateral flow. Patients and methods: Five patients post deep venous thrombosis in the context of azygos continuation were followed up clinically and with colour duplex ultrasonography. Results: All five patients had to our knowledge after the initial deep venous thrombosis no further thromboembolic events. Three patients after isolated iliac thromboses are symptom free or nearly symptom free, two after more extended thromboses still suffer from venous claudication. Four patients are without anticoagulation, one patient is permanently orally anticoagulated. Conclusions: Azygos continuation may not influence the risk of recurrent venous thrombo-embolism nor the outcome of a deep venous thrombosis. Careful deep venous thrombosis prophylaxis in patients with azygos continuation may be sufficient when a risk factor is present but conclusions lack due to the small numbers of patients of enough supportive data.

scholarly journals EPID-10. VENOUS THROMBOEMBOLIC EVENTS IN GLIOBLASTOMA PATIENTS: AN EPIDEMIOLOGICAL VIEW

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi76-vi76
Author(s):  
Dorothee Gramatzki ◽  
Patrick Roth ◽  
Emilie Le Rhun ◽  
Elisabeth Rushing ◽  
Sabine Rohrmann ◽  
...  
Keyword(s):  
Survival Data ◽  
Time Frame ◽  
Rank Test ◽  
Karnofsky Performance Score ◽  
Thromboembolic Events ◽  
Therapeutic Anticoagulation ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Abstract BACKGROUND Venous thromboembolic events (VTE) are a common complication in cancer patients. Anticoagulant use is the appropriate treatment for acute VTE in cancer, although assumed to be associated with increased risk for bleeding. The population-based relationship of VTE and anticoagulant therapy to survival in glioblastoma patients remains unclear. METHODS Frequency, risk factors, treatment and complications of VTE were assessed in a glioblastoma cohort in the Canton of Zurich, Switzerland (2010 to 2014). Survival data were retrospectively analyzed using the log rank test. RESULTS 248 glioblastoma patients with known isocitrate dehydrogenase (IDH) wildtype status were identified in a 5-year time-frame. Median overall survival (OS) was 12.8 months (95% CI 11.0–14.6), with a median follow up of 60.7 months (95% CI 51.4–70.0). VTE were diagnosed in 35 patients (14.4%; 5 out of 248 patients with no follow-up data on VTE). Median time from diagnosis to VTE was 2.23 months (95% CI 0.6–3.9); 3 patients (8.6%) had a history of VTE. Most patients were on steroids at time of diagnosis of VTE (68.6%), and a Karnofsky Performance Score of less than 70% was documented in 21 patients (60%). Most patients with VTE (88.6%) received therapeutic anticoagulation. Complications, resulting in the cessation of therapeutic anticoagulation, occurred in 11 patients (35.5%), mainly (9 patients, 81.8%) due to intracranial hemorrhage. OS did not differ between patients diagnosed with VTE and those without VTE (p=0.103). Tumor progression was the major cause of death (91.3%); 1.4% of patients died from VTE; 1.9% of the patients suffered unexpected sudden death. CONCLUSION Although VTE were identified in 14.4% of glioblastoma patients, VTE were not the major reason for death. These data do not support the implementation of primary thromboprophylaxis in glioblastoma patients. Prospective clinical trials are needed to examine the association of anticoagulant use with survival in glioblastoma patients.

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