A Simple Way to Improve DVT Protocol Compliance

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%.

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The Impact of Duplex Scanning for the Diagnosis of Deep Vein Thrombosis on Workload in a District General Hospital

Phlebology The Journal of Venous Disease ◽

10.1007/s005239970003 ◽

1999 ◽

Vol 14 (4) ◽

pp. 143-145 ◽

Cited By ~ 1

Author(s):

S. Sudhindran ◽

S. Rosser ◽

W. J. Pilbrow ◽

G. R. J. Sissons ◽

L. M. de Cossart

Keyword(s):

Deep Vein Thrombosis ◽

General Hospital ◽

District General Hospital ◽

Duplex Scanning ◽

Vein Thrombosis ◽

Deep Vein ◽

The Impact

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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.

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

Thrombosis ◽

10.1155/2011/629383 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Gregory Cheng ◽

Crystal Chan ◽

Ying Ting Liu ◽

Yee Fun Choy ◽

Mei Mei Wong ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Doppler Ultrasound ◽

Medical Patients ◽

Ultrasound Studies ◽

Vein Thrombosis ◽

Dvt Prophylaxis ◽

Medical Wards ◽

Deep Vein ◽

The Impact

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.

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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.

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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.

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The Impact of Duplex Scanning for the Diagnosis of Deep Vein Thrombosis on Workload in a District General Hospital

Phlebology The Journal of Venous Disease ◽

10.1177/026835559901400403 ◽

1999 ◽

Vol 14 (4) ◽

pp. 143-145 ◽

Cited By ~ 1

Author(s):

S. Sudhindran ◽

S. Rosser ◽

W. J. Pilbrow ◽

G. R. J. Sissons ◽

L. M. de Cossart

Keyword(s):

Deep Vein Thrombosis ◽

General Hospital ◽

Screening Tool ◽

Fold Increase ◽

District General Hospital ◽

Vein Thrombosis ◽

Retrospective Audit ◽

Vascular Laboratory ◽

Deep Vein ◽

The Impact

Objective: To assess the impact of changing from ascending phlebography to colour flow duplex (CFD) scanning for the investigation of deep vein thrombosis (DVT) in a District General Hospital and to determine the role of light reflection rheology (LRR) as a Preliminary screening tool for DVT. Design: Retrospective audit. Setting: Vascular Laboratory and Department of Radiology of the Countess of Chester Hospital, Chester, UK. Patients and methods: Audit and review of the all venograms done during the years 1989 to 1991 was undertaken. All the LRR and CFD scans done from 1991 (year of introduction in this hospital) to 1996 were audited and analysed. Outcome measures: Total number of various investigations done for suspected DVT in this hospital from 1989 to 1996 and their detailed analysis. Results: Four hundred and ninety-four venograms were performed between 1989 and 1991, of which 44% confirmed DVT. The least number of venograms was performed in 1991 ( n = 127), after the introduction of LRR. From 1991 through to 1996, the number of LRR scans increased from 90 to 697 and the CFD scans increased from 97 to 786. Conclusion: The audit revealed a 6-fold increase in demand for the examination of limbs for suspected DVT after the introduction of non-invasive tests. LRR continues to be a useful screening tool, reducing the number of CFD scans by 23%.

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The Hemodynamic and Fibrinolytic Response to Low Dose Epinephrine and Phenylephrine Infusions During Total Hip Replacement Under Epidural Anesthesia

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646293 ◽

1992 ◽

Vol 68 (04) ◽

pp. 436-441 ◽

Cited By ~ 23

Author(s):

Nigel E Sharrock ◽

George Go ◽

Robert Mineo ◽

Peter C Harpel

Keyword(s):

Heart Rate ◽

Deep Vein Thrombosis ◽

Cardiac Index ◽

Total Hip Replacement ◽

Epidural Anesthesia ◽

Hip Replacement ◽

Low Dose ◽

Total Hip ◽

Vein Thrombosis ◽

Deep Vein

SummaryLower rates of deep vein thrombosis have been noted following total hip replacement under epidural anesthesia in patients receiving exogenous epinephrine throughout surgery. To determine whether this is due to enhanced fibrinolysis or to circulatory effects of epinephrine, 30 patients scheduled for primary total hip replacement under epidural anesthesia were randomly assigned to receive intravenous infusions of either low dose epinephrine or phenylephrine intraoperatively. All patients received lumbar epidural anesthesia with induced hypotension and were monitored with radial artery and pulmonary artery catheters.Patients receiving low dose epinephrine infusion had maintenance of heart rate and cardiac index whereas both heart rate and cardiac index declined significantly throughout surgery in patients receiving phenylephrine (p = 0.0001 and p = 0.0001, respectively). Tissue plasminogen activator (t-PA) activity increased significantly during surgery (p <0.0005) and declined below baseline postoperatively (p <0.005) in both groups. Low dose epinephrine was not associated with any additional augmentation of fibrinolytic activity perioperatively. There were no significant differences in changes in D-Dimer, t-PA antigen, α2-plasmin inhibitor-plasmin complexes or thrombin-antithrombin III complexes perioperatively between groups receiving low dose epinephrine or phenylephrine. The reduction in deep vein thrombosis rate with low dose epinephrine is more likely mediated by a circulatory mechanism than by augmentation of fibrinolysis.

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Low-Dose Heparin and Deep-Vein Thrombosis after Total Hip Replacement

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648020 ◽

1976 ◽

Vol 36 (01) ◽

pp. 157-164 ◽

Cited By ~ 34

Author(s):

P. M Mannucci ◽

Luisa E. Citterio ◽

N Panajotopoulos

Keyword(s):

Deep Vein Thrombosis ◽

Total Hip Replacement ◽

Hip Replacement ◽

Low Dose ◽

Control Group ◽

Total Hip ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin

SummaryThe effect of subcutaneous low-dose heparin on postoperative deep-vein thrombosis (D. V. T.) (diagnosed by the 125I-labelled fibrinogen test) has been investigated in a trial of 143 patients undergoing the operation of total hip replacement. Two randomized studies were carried out: in one the scanning for D.V.T. was carried out daily for 7 days post operatively and in the other for 15 days. In both, the incidence of D.V.T. was significantly lower in the heparin-treated patients (P<0.005). Bilateral D.V.T. was also prevented (P<0.05), through the extension of D.V.T. to the distal veins of the thigh was not significantly reduced. Heparin treatment was, however, followed by a higher incidence of severe postoperative bleeding (P< 0.02) and wound haematoma formation (P< 0.005), and the postoperative haemoglobin was significantly lower than in the control group (P<0.005). A higher number of transfused blood units was also needed by the heparin treated patients (P<0.001).

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Intensive Initial Oral Anticoagulation and Shorter Heparin Treatment in Deep Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661195 ◽

1984 ◽

Vol 52 (03) ◽

pp. 276-280 ◽

Cited By ~ 17

Author(s):

Sam Schulman ◽

Dieter Lockner ◽

Kurt Bergström ◽

Margareta Blombäck

Keyword(s):

Deep Vein Thrombosis ◽

Oral Anticoagulation ◽

Dose Group ◽

Low Dose ◽

Clinical Signs ◽

Coagulation Factor ◽

High Dose ◽

Vein Thrombosis ◽

Heparin Treatment ◽

Deep Vein

SummaryIn order to investigate whether a more intensive initial oral anticoagulation still would be safe and effective, we performed a prospective randomized study in patients with deep vein thrombosis. They received either the conventional regimen of oral anticoagulation (“low-dose”) and heparin or a more intense oral anticoagulation (“high-dose”) with a shorter period of heparin treatment.In the first part of the study 129 patients were randomized. The “low-dose” group reached a stable therapeutic prothrombin complex (PT)-level after 4.3 and the “high-dose” group after 3.3 days. Heparin was discontinued after 6.0 and 5.0 days respectively. There was no difference in significant hemorrhage between the groups, and no clinical signs of progression of the thrombosis.In the second part of the study another 40 patients were randomized, followed with coagulation factor II, VII, IX and X and with repeated venograms. A stable therapeutic PT-level was achieved after 4.4 (“low-dose”) and 3.7 (“high-dose”) days, and heparin was discontinued after 5.4 and 4.4 days respectively. There were no clinical hemorrhages, the activity of the coagulation factors had dropped to the same level in both groups at the time when heparin was discontinued and no thromboembolic complications occurred.Our oral anticoagulation regimen with heparin treatment for an average of 4.4-5 days seems safe and reduces in-patient costs.

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