Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis

2016 ◽  
Vol 115 (03) ◽  
pp. 608-614 ◽  
Author(s):  
Krishna Patel ◽  
Kevin Chagin ◽  
Pichapong Tunsupon ◽  
Pojchawan Yampikulsakul ◽  
Gautam V. Shah ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Cleveland Clinic ◽  
Proximal Deep Vein Thrombosis ◽  
Final Model ◽  
Vein Thrombosis ◽  
C Statistic ◽  
Two Factors ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

SummaryIsolated distal deep-vein thrombosis (DDVT) of the lower extremities can be associated with subsequent proximal deep-vein thrombosis (PDVT) and/or acute pulmonary embolism (PE). We aimed to develop a model predicting the probability of developing PDVT and/or PE within three months after an isolated episode of DDVT. We conducted a retrospective cohort study of patients with symptomatic DDVT confirmed by lower extremity vein ultrasounds between 2001–2012 in the Cleveland Clinic Health System. We reviewed all the ultrasounds, chest ventilation/perfusion and computed tomography scans ordered within three months after the initial DDVT to determine the incidence of PDVT and/or PE. A multiple logistic regression model was built to predict the rate of developing these complications. The final model included 450 patients with isolated DDVT. Within three months, 30 (7%) patients developed an episode of PDVT and/or PE. Only two factors predicted subsequent thromboembolic complications: inpatient status (OR, 6.38; 95 % CI, 2.17 to 18.78) and age (OR, 1.02 per year; 95 % CI, 0.99 to 1.05). The final model had a bootstrap bias-corrected c-statistic of 0.72 with a 95 % CI (0.64 to 0.79). Outpatients were at low risk (<4 %) of developing PDVT/PE. Inpatients aged ≥ 60 years were at high risk (> 10%). Inpatients aged < 60 were at intermediate risk. We created a simple model that can be used to risk stratify patients with isolated DDVT based on inpatient status and age. The model might be used to choose between anticoagulation and monitoring with serial ultrasounds.

scholarly journals Profile of Patients with Isolated Distal Deep Vein Thrombosis versus Proximal Deep Vein Thrombosis or Pulmonary Embolism: RE-COVERY DVT/PE Study

2021 ◽  
Author(s):  
Sebastian Schellong ◽  
Walter Ageno ◽  
Ivan B. Casella ◽  
Kok Han Chee ◽  
Sam Schulman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Varicose Veins ◽  
Oral Anticoagulants ◽  
Patient Characteristics ◽  
Global Perspective ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

AbstractIsolated distal deep vein thrombosis (IDDVT) is presumed to be more benign than proximal DVT (PDVT) or pulmonary embolism (PE), suggesting a need for different management approaches. This subgroup analysis of the RE-COVERY DVT/PE global, observational study investigated patient characteristics, hospitalization details, and anticoagulant therapy in patients with IDDVT in real-world settings in 34 countries enrolled from January 2016 to May 2017. Data were analyzed descriptively according to the type and location of the index venous thromboembolism (VTE): IDDVT, PDVT ± distal DVT (DDVT), and PE ± DVT. Of the 6,095 eligible patients, 323 with DVT located outside the lower limb and no PE were excluded. Of the remaining 5,772 patients, 17.6% had IDDVT, 39.9% had PDVT ± DDVT, and 42.5% had PE ± DVT. IDDVT patients were younger and had fewer risk factors for VTE than the other groups. Other comorbidities were less frequent in the IDDVT group, except for varicose veins, superficial thrombophlebitis, and venous insufficiency. IDDVT patients were less likely to be diagnosed in an emergency department (22.3 vs. 29.7% for PDVT ± DDVT and 45.4% for PE ± DVT) or hospitalized for VTE (29.2 vs. 48.5% for PDVT ± DDVT and 75.0% for PE ± DVT). At hospital discharge or 14 days after diagnosis (whichever was later), non–vitamin K antagonist oral anticoagulants were the most commonly used anticoagulants (55.6% for IDDVT, 54.7% for PDVT ± DDVT, and 52.8% for PE ± DVT). Although differences in patient characteristics, risk factors, and clinical management were identified, anticoagulant treatment of IDDVT was almost equal to that of PDVT or PE. Prospective studies should investigate whether, in a global perspective, this is an appropriate use of anticoagulants. Trial registration number ClinicalTrials.gov NCT02596230.

scholarly journals Pulmonary embolism and screening for concomitant proximal deep vein thrombosis in noncritically ill hospitalized patients with coronavirus disease 2019.

2020 ◽  
Author(s):  
Álvaro Dubois-Silva ◽  
Cristina Barbagelata-López ◽  
Álvaro Mena ◽  
Patricia Piñeiro-Parga ◽  
Diego Llinares-García ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Point Of Care ◽  
Hospitalized Patients ◽  
Lower Limbs ◽  
Proximal Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Reactive Protein ◽  
Deep Vein ◽  
Vessel Thrombosis

Abstract Background The clinical characteristics of noncritically ill patients with coronavirus disease 2019 (COVID-19) who develop pulmonary embolism (PE) and the prevalence of concomitant proximal deep-vein thrombosis (DVT) of the lower limbs have not been evaluated consistently.Methods We identified nonintensive care unit (non-ICU) patients admitted with COVID-19 who were diagnosed with PE at a single center in northwest Spain. Point-of-care compression ultrasonography (CUS) of the lower limbs was performed to screen for concomitant proximal DVT. Clinical data were analyzed retrospectively.Results From April 2 to April 17, 2020, 8 patients with COVID-19 and PE were identified. PE was diagnosed a median of 19 (interquartile range [IQR], 17–23) days after onset of COVID-19 symptoms and a median of 13 (IQR, 8–15) days after admission. All patients received thromboprophylaxis with enoxaparin or biosimilar at a median dose of 40 mg. All tested patients had high levels of D-dimer (≥2000 ng/mL), serum ferritin (≥300 mg/dL) and IL-6 (≥5 pg/mL) at PE diagnosis. Six (75%) and 7 (87.5%) patients had high C-reactive-protein (≥1 mg/dL) and lactate dehydrogenase (≥250 U/L) levels, respectively. All PE events were segmental or subsegmental, with lobar involvement in only one. None of these patients had concomitant proximal DVT of the lower limbs on CUS.Conclusions Non-ICU hospitalized patients with COVID-19 diagnosed with PE had mainly segmental or subsegmental events without concomitant proximal DVT of the lower limbs. Our findings suggest a predominance of small-vessel thrombosis secondary to inflammatory and immune responses in these patients.

scholarly journals Proximal Deep Vein Thrombosis and Pulmonary Embolism in COVID-19 Patients: A Systematic Review and Meta-Analysis Short Tittle: Venous Thromboembolism in COVID-19 Patients

2020 ◽  
Author(s):  
Gregoire Longchamp ◽  
Sara Manzocchi-Besson ◽  
Alban Longchamp ◽  
Marc Righini ◽  
Helia Robert-Ebadi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Meta Analysis ◽  
Proximal Deep Vein Thrombosis ◽  
Primary Analysis ◽  
Thrombotic Risk ◽  
Medically Ill ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract BACKGROUNGCOVID-19 appears to be associated with a high risk of venous thromboembolism (VTE). We aimed to systematically review and meta-analyze the risk of clinically relevant VTE in patients hospitalized for COVID-19. METHODSThis meta-analysis included original articles in English published from 01/01/2020 to 06/15/2020 in Pubmed/MEDLINE, Embase, Web of science, and Cochrane. Outcomes were major VTE, defined as any objectively diagnosed pulmonary embolism (PE) and/or proximal deep vein thrombosis (DVT). Primary analysis estimated the risk of VTE, stratified by acutely and critically ill inpatients. Secondary analyses explored the separate risk of proximal DVT and of PE; the risk of major VTE stratified by screening and by type of anticoagulation. RESULTSIn 33 studies (n=4’009 inpatients) with heterogeneous thrombotic risk factors, VTE incidence was 9% (95%CI 5-13%, I2=92.5) overall, and 21% (95%CI 14-28%, I2=87.6%) for patients hospitalized in the ICU. Proximal lower limb DVT incidence was 3% (95%CI 1-5%, I2= 87.0%) and 8% (95%CI 3-14%, I2=87.6%), respectively. PE incidence was 8% (95%CI 4-13%, I2=92.1%) and 17% (95%CI 11-25%, I2=89.3%), respectively. Screening and absence of anticoagulation were associated with a higher VTE incidence. When restricting to medically ill inpatients, the VTE incidence was 2% (95%CI 0-6%).CONCLUSIONSThe risk of major VTE among COVID-19 inpatients is high but varies greatly with severity of the disease. These findings reinforce the need for the use of thromboprophylaxis in all COVID-19 inpatients and for clinical trials testing different thromboprophylaxis regimens in subgroups of COVID-19 inpatients. TRIAL REGISTRATIONThe review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020193369).

Sign in / Sign up

Export Citation Format

Share Document