scholarly journals Association Between Asymptomatic Proximal Deep Vein Thrombosis and Mortality in Acutely Ill Medical Patients

2021 ◽  
Author(s):  
Gary E. Raskob ◽  
Alex C. Spyropoulos ◽  
Alexander T. Cohen ◽  
Jeffrey I. Weitz ◽  
Walter Ageno ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Proportional Hazards Model ◽  
Cohort Analysis ◽  
Cox Proportional Hazards Model ◽  
Proximal Deep Vein Thrombosis ◽  
Medical Patients ◽  
Vein Thrombosis ◽  
End Point ◽  
Compression Ultrasound ◽  
Deep Vein

Background Asymptomatic proximal deep vein thrombosis (DVT) is an end point frequently used to evaluate the efficacy of anticoagulant thromboprophylaxis in medical patients. Recently, the clinical relevance of asymptomatic DVT has been challenged. Methods and Results The objective of this study was to evaluate the relationship between asymptomatic proximal DVT and all‐cause mortality (ACM) using a cohort analysis of a randomized trial for the prevention of venous thromboembolism (VTE) in acutely ill medical patients. Patients who received at least 1 dose of study drug and had an adequate compression ultrasound examination of the legs on either day 10 or day 35 were categorized into 1 of 3 cohorts: no VTE, asymptomatic proximal DVT, or symptomatic DVT. Cox proportional hazards model, with adjustment for significant independent predictors of mortality, were used to compare the incidences of ACM. Of the 7036 patients, 6776 had no VTE, 236 had asymptomatic DVT, and 24 had symptomatic VTE. The incidence of ACM was 4.8% in patients without VTE. Both asymptomatic proximal DVT (mortality, 11.4%; hazard ratio [HR], 2.31; 95% CI, 1.52–3.51; P <0.0001) and symptomatic VTE (mortality, 29.2%; HR, 9.42; 95% CI, 4.18–21.20; P <0.0001) were independently associated with significant increases in ACM. The analysis was post hoc, and ultrasound results were not available for all patients. Adjustment for baseline variables significantly associated with ACM may not fully compensate for differences. Conclusions Asymptomatic proximal DVT is associated with higher ACM than no VTE and remains a relevant end point to evaluate the efficacy of anticoagulant thromboprophylaxis in medical patients. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00571649.

scholarly journals Accuracy of three-point compression ultrasound for the diagnosis of proximal deep-vein thrombosis in emergency department

2019 ◽  
Vol 24 (1) ◽  
pp. 80 ◽  
Author(s):  
RaziehSadat Mousavi-Roknabadi ◽  
Afsaneh Dehbozorgi ◽  
Fatemeh Damghani ◽  
Mehrdad Sharifi ◽  
SeyedMahmoudreza Sajjadi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Deep Vein Thrombosis ◽  
Proximal Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Compression Ultrasound ◽  
Point Compression ◽  
Deep Vein

scholarly journals Predictors of long-term post-thrombotic syndrome following high proximal deep vein thrombosis: a cross-sectional study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Marit Engeseth ◽  
Tone Enden ◽  
Per Morten Sandset ◽  
Hilde Skuterud Wik
Keyword(s):  
Deep Vein Thrombosis ◽  
Proximal Deep Vein Thrombosis ◽  
Cross Sectional ◽  
Clinical Criteria ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Younger Age ◽  
Deep Vein

Abstract Background Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT. Methods During 2006–09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (> 1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression. Results Eighty-eight patients (52%) were included 8–10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93–0.99), and 1.23 (95% CI, 1.02–1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments. Conclusions In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.

Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients

2005 ◽  
Vol 93 (01) ◽  
pp. 76-79 ◽  
Author(s):  
Alain Leizorovicz ◽  
Alexander Cohen ◽  
Alexander Turpie ◽  
Carl-Gustav Olsson ◽  
Samuel Goldhaber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Mortality Rates ◽  
Hazard Ratio ◽  
Group Iii ◽  
Vein Thrombosis ◽  
Group I ◽  
Compression Ultrasound ◽  
The Difference ◽  
Deep Vein

SummaryThe clinical importance of asymptomatic proximal and distal deep vein thrombosis (DVT) remains uncertain and controversial. The aim of this retrospective,post-hoc analysis was to examine mortality and risk factors for development of proximal DVT in hospitalized patients with acute medical illness who were recruited into a randomized, prospective clinical trial of thromboprophylaxis with dalteparin (PREVENT).We analyzed 1738 patients who had not sustained a symptomatic venous thromboembolic event by Day 21 and who had a complete compression ultrasound of the proximal and distal leg veins on Day 21. We examined the 90-day mortality rates in patients with asymptomatic proximal DVT (Group I, N = 80), asymptomatic distal DVT (Group II, N = 118) or no DVT (Group III, N = 1540).The 90-day mortality rates were 13.75%, 3.39%, and 1.92% for Groups I–III, respectively. The difference in mortality between Group I and Group III was significant (hazard ratio 7.63, 95% CI = 3.8–15.3;p < 0.0001),whereas the difference between Groups II and III did not reach significance (hazard ratio 1.36, 95% CI = 0.41–4.45).The association of asymptomatic proximal DVT with increased mortality remained highly significant after adjusting for differences in baseline demographics and clinical variables. Risk factors significantly associated with the development of proximal DVT included advanced age (p = 0.0005), prior DVT (p = 0.001), and varicose veins (p = 0.04). In conclusion, the high mortality rate in patients with asymptomatic proximal DVT underscores its clinical relevance and supports targeting of asymptomatic proximal DVT as an appropriate endpoint in clinical trials of thromboprophylaxis.

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