Prevention of Recurrent Deep Venous Thrombosis with Indobufen. A 3-Year Follow-up Study Using Color Duplex Scanning

1. The purpose of the study was to evaluate the degree of thrombus regression, development of valvular insufficiency, impaired calf muscle pump function and clinical symptoms after a period of acute deep venous thrombosis. 2. Seventy patients with acute deep venous thrombosis, diagnosed by duplex scanning or venography, received treatment with heparin and oral coumarin derivatives according to a standard protocol. All patients wore graduated compression stockings during the whole study period. Duplex scanning was performed at diagnosis and 1 and 3 months later to measure thrombus mass and reflux. The supine venous pump function test was used to assess calf muscle pump function. 3. Three months follow-up was completed in 60 patients. In total 218 (28%) out of 780 vein segments were initially thrombosed and 134 (17%) could not be traced. A statistically significant reduction of thrombus mass was recorded throughout the study period. Total resolution of thrombosis in all vein segments occurred in 25% of the patients within 1 month and in 40% in 3 months. There was no difference in regression between the various proximal vein segments. Distal segments showed more regression than proximal segments. Reflux occurred in 27% of the initially thrombosed veins and in 15% of the patent veins. Patients who showed total resolution after 1 month had a significantly higher calf muscle pump function than patients without total resolution (70%pf vs 61%pf, P < 0.05). Patients with reflux in two or more segments had a significantly lower calf muscle pump function than patients with reflux in less than two segments (58%pf vs 69%pf, P < 0.05). 4. Using duplex scanning and the supine venous pump function test 3 months after an acute deep venous thrombosis, overall haemodynamic abnormalities and local site of valve incompetence could readily be identified. Patients with haemodynamic abnormalities might be at risk to develop the post-thrombotic syndrome. There was no difference in thrombus regression between the various proximal vein segments. Reflux was significantly more often seen in initially thrombosed veins. Thirty-five percent of the patients developed an abnormal calf muscle pump function after 3 months. Patients with early resolution of thrombus had a higher calf muscle pump function after 3 months.

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The development of valvular incompetence after deep vein thrombosis: A follow-up study with duplex scanning

Journal of Vascular Surgery ◽

10.1016/s0741-5214(94)70218-7 ◽

1994 ◽

Vol 19 (6) ◽

pp. 1059-1066 ◽

Cited By ~ 55

Author(s):

Bert van Ramshorst ◽

Paul S. van Bemmelen ◽

Hans Hoeneveld ◽

Bert C. Eikelboom

Keyword(s):

Deep Vein Thrombosis ◽

Duplex Scanning ◽

Vein Thrombosis ◽

Follow Up Study ◽

Deep Vein

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High incidence of patients lost to follow-up after venous thromboembolism diagnosis – Identifying an unmet need for targeted transition of care

Vascular ◽

10.1177/17085381211020969 ◽

2021 ◽

pp. 170853812110209

Author(s):

Rae S Rokosh ◽

Jack H Grazi ◽

David Ruohoniemi ◽

Eugene Yuriditsky ◽

James Horowitz ◽

...

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Time Of Day ◽

Transition Of Care ◽

Initial Discharge ◽

Significant Difference

Objectives Venous thromboembolism, including deep venous thrombosis and pulmonary embolism, is a major source of morbidity, mortality, and healthcare utilization. Given the prevalence of venous thromboembolism and its associated mortality, our study sought to identify factors associated with loss to follow-up in venous thromboembolism patients. Methods This is a single-center retrospective study of all consecutive admitted (inpatient) and emergency department patients diagnosed with acute venous thromboembolism via venous duplex examination and/or chest computed tomography from January 2018 to March 2019. Patients with chronic deep venous thrombosis and those diagnosed in the outpatient setting were excluded. Lost to venous thromboembolism-specific follow-up (LTFU) was defined as patients who did not follow up with vascular, cardiology, hematology, oncology, pulmonology, or primary care clinic for venous thromboembolism management at our institution within three months of initial discharge. Patients discharged to hospice or dead within 30 days of initial discharge were excluded from LTFU analysis. Statistical analysis was performed using STATA 16 (College Station, TX: StataCorp LLC) with a p-value of <0.05 set for significance. Results During the study period, 291 isolated deep venous thrombosis, 25 isolated pulmonary embolism, and 54 pulmonary embolism with associated deep venous thrombosis were identified in 370 patients. Of these patients, 129 (35%) were diagnosed in the emergency department and 241 (65%) in the inpatient setting. At discharge, 289 (78%) were on anticoagulation, 66 (18%) were not, and 15 (4%) were deceased. At the conclusion of the study, 120 patients (38%) had been LTFU, 85% of whom were discharged on anticoagulation. There was no statistically significant difference between those LTFU and those with follow-up with respect to age, gender, diagnosis time of day, venous thromboembolism anatomic location, discharge unit location, or anticoagulation choice at discharge. There was a non-significant trend toward longer inpatient length of stay among patients LTFU (16.2 days vs. 12.3 days, p = 0.07), and a significant increase in the proportion of LTFU patients discharged to a facility rather than home ( p = 0.02). On multivariate analysis, we found a 95% increase in the odds of being lost to venous thromboembolism-specific follow-up if discharged to a facility (OR 1.95, CI 1.1–3.6, p = 0.03) as opposed to home. Conclusions Our study demonstrates that over one-third of patients diagnosed with venous thromboembolism at our institution are lost to venous thromboembolism-specific follow-up, particularly those discharged to a facility. Our work suggests that significant improvement could be achieved by establishing a pathway for the targeted transition of care to a venous thromboembolism-specific follow-up clinic.

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Long-term Clinical Follow-up in 265 Patients with Deep Venous Thrombosis Initially Treated with either Unfractionated Heparin or Dalteparin: A Retrospective Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614364 ◽

1999 ◽

Vol 82 (10) ◽

pp. 1222-1226 ◽

Cited By ~ 16

Author(s):

W. Åberg ◽

D. Lockner ◽

C. Paul ◽

M. Holmström

Keyword(s):

Risk Factor ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Unfractionated Heparin ◽

Malignant Disease ◽

Duration Of Treatment ◽

Post Thrombotic Syndrome ◽

Recurrent Vte

SummaryThe primary objective of this retrospective study was to describe the frequency of a post-thrombotic syndrome in 265 patients previously treated for deep venous thrombosis (DVT). The secondary objectives were to document the frequency of recurrent venous thromboembolism (VTE) and mortality, especially from malignant disease. The patients were evaluated 5-14 years after inclusion in three randomized trials comparing continuous intravenous (i. v.) infusion of unfractionated heparin (UFH) (n = 85) with a low molecular weight heparin (LMWH), dalteparin (n = 180). The median post-thrombotic score at follow-up was 2 (range 0-8). In a multiple step-wise regression analysis the post-thrombotic score was significantly higher among patients with initial proximal DVT (p = 0,0001) as compared with those who had distal DVT. A recurrent venous thromboembolic event was diagnosed in 29,4% of the patients treated with dalteparin and in 23,5% of the patients treated with UFH (ns). A secondary risk factor for venous thromboembolism and a longer duration of treatment with oral anticoagulants (OAC) were significantly associated with a lower risk for recurrent VTE, whereas malignant disease diagnosed during follow-up was associated with a higher risk. During follow-up a total of 40,7% of patients had died. No difference in total mortality or mortality from malignant disease was demonstrated between the two drugs. In conclusion, a severe post-thrombotic syndrome occured relatively infrequent. considering the long observation period. Proximal DVT was significantly associated with a more severe post-thrombotic syndrome. After 14 years follow-up, no significant differences were observed in overall mortality, mortality from malignant disease or recurrent VTE between UFH- and dalteparin-treated patients. Malignant disease was a risk factor for recurrent VTE, the presence of a secondary risk factor and a longer duration of treatment with OAC decreased the risk for recurrent VTE.

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Statin use and risk of recurrent venous thrombosis: results from the MEGA follow-up study

Research and Practice in Thrombosis and Haemostasis ◽

10.1002/rth2.12003 ◽

2017 ◽

Vol 1 (1) ◽

pp. 112-119 ◽

Cited By ~ 3

Author(s):

Sigrid K. Braekkan ◽

Camila Caram-Deelder ◽

Bob Siegerink ◽

Astrid van Hylckama Vlieg ◽

Saskia le Cessie ◽

...

Keyword(s):

Venous Thrombosis ◽

Follow Up Study ◽

Recurrent Venous Thrombosis ◽

Statin Use

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D-Dimer Determination to Assess Regression of Deep Venous Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657631 ◽

1997 ◽

Vol 78 (02) ◽

pp. 799-802 ◽

Cited By ~ 12

Author(s):

M C H Janssen ◽

H Verbruggen ◽

H Wollersheim ◽

B Hoogkamer ◽

H van Langen ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Odds Ratio ◽

Initial Treatment ◽

Heparin Therapy ◽

Duplex Scanning ◽

Fibrinolytic Parameters ◽

The Relationship ◽

Insight Into ◽

D Dimer

SummaryA number of studies evaluating deep venous thrombosis (DVT) have demonstrated that plasma levels of thrombotic and fibrinolytic parameters change during treatment, but the relationship between thrombus regression and evolution of these markers remains unknown. The objective of the present study was to correlate levels of D-Dimer (DD) with thrombus regression as assessed by duplex scanning.From 44 patients treated for acute DVT, DD were determined at diagnosis and at the end of initial heparin therapy of at least 5 days. Thrombus regression was measured by repeated duplex scanning at diagnosis and after 1 and 3 months.DD significantly decreased during heparin treatment as compared with values at presentation. DD levels were significantly higher in the group of patients without normalization of the DVT after 3 months (p = 0.003). A ninefold excess tendency was seen for DD levels > 1200 ng/ml at the end of initial treatment to be associated with poor resolution of the DVT [odds ratio 9.0, 0.95 confidence interval (CI) 2.3-35.4]. When the patients with an established malignancy were excluded, the differences were even more significant (p = 0.0004 for DD levels after initial treatment and an odds ratio of 17.5, 0.95 CI 3.3-92.5).These results suggest that increased DD levels after the initial phase of treatment are related to poor resolution of DVT after 3 months. These findings contribute to further insight into the process of thrombus regression. Furthermore high DD levels might help to identify the patients with a poor prognosis and could be useful to judge the efficacy of anticoagulant treatment.

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Deep Venous Thrombosis of the Upper Limbs

Phlebology The Journal of Venous Disease ◽

10.1177/026835558800300109 ◽

1988 ◽

Vol 3 (1) ◽

pp. 63-68 ◽

Cited By ~ 10

Author(s):

Haim Gutman ◽

Meir Peri ◽

Avigdor Zelikovski ◽

Menashe Haddad ◽

Raphael Reiss

Keyword(s):

Natural History ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Surgical Approach ◽

Symptomatic Treatment ◽

Consensus Conference ◽

Natural Course ◽

Upper Limbs ◽

Fibrinolytic Agents

Deep venous thrombosis of the upper limbs is rare and represents less than 2-3% of all cases of deep venous thrombosis. Reviewing our series of 25 patients we decided that follow-up and symptomatic treatment produce acceptable results, since the disease has a benign natural history. Fibrinolytic agents administered under strict limitations (The Consensus Conference 1980, Ann Int Med) are efficient in early cases, but its ability to change the natural course of the disease has not been proved. Surgical approach should be reserved for cases with secondary ischaemia and/or a resectable extraluminal mass.

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