Natural history of deep vein thrombosis in children

2014 ◽  
Vol 30 (6) ◽  
pp. 412-417 ◽  
Author(s):  
G Spentzouris ◽  
A Gasparis ◽  
RJ Scriven ◽  
TK Lee ◽  
N Labropoulos
Keyword(s):  
Deep Vein Thrombosis ◽  
Signs And Symptoms ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
History Of ◽  
Recurrent Deep Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Objective To determine the natural history of deep vein thrombosis in children presented with a first episode in the lower extremity veins. Methods Children with objective diagnosis of acute deep vein thrombosis were followed up with ultrasound and clinical examination. Risk factors and clinical presentation were prospectively collected. The prevalence of recurrent deep vein thrombosis and the development of signs and symptoms of chronic venous disease were recorded. Results There were 27 children, 15 males and 12 females, with acute deep vein thrombosis, with a mean age of 4 years, range 0.1–16 years. The median follow-up was 23 months, range 8–62 months. The location of thrombosis involved the iliac and common femoral vein in 18 patients and the femoral and popliteal veins in 9. Only one vein was affected in 7 children, two veins in 14 and more than two veins in 6. Recurrent deep vein thrombosis occurred in two patients, while no patient had a clinically significant pulmonary embolism. Signs and symptoms of chronic venous disease were present at last follow-up in 11 patients. There were nine patients with vein collaterals, but no patient developed varicose veins. Reflux was found in 18 veins of 11 patients. Failure of recanalization was seen in 7 patients and partial recanalization in 11. Iliofemoral thrombosis ( p = 0.012) and failure to recanalize ( p = 0.036) increased significantly the risk for developing signs and symptoms. Conclusions Children with acute proximal deep vein thrombosis develop mild chronic venous disease signs and symptoms at mid-term follow-up and are closely related with iliofemoral thrombosis and failure to recanalization.

scholarly journals Recanalization after acute deep vein thrombosis

2013 ◽  
Vol 12 (4) ◽  
pp. 296-302 ◽  
Author(s):  
Gustavo Mucoucah Sampaio Brandao ◽  
Marcone Lima Sobreira ◽  
Hamilton Almeida Rollo
Keyword(s):  
Deep Vein Thrombosis ◽  
Vessel Wall ◽  
Lower Limbs ◽  
Venous Disease ◽  
Natural Evolution ◽  
Vein Thrombosis ◽  
Complex Process ◽  
History Of ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

The process of recanalization of the veins of the lower limbs after an episode of acute deep venous thrombosis is part of the natural evolution of the remodeling of the venous thrombus in patients on anticoagulation with heparin and vitamin K inhibitors. This remodeling involves the complex process of adhesion of thrombus to the wall of the vein, the inflammatory response of the vessel wall leading to organization and subsequent contraction of the thrombus, neovascularization and spontaneous lysis of areas within the thrombus. The occurrence of spontaneous arterial flow in recanalized thrombosed veins has been described as secondary to neovascularization and is characterized by the development of flow patterns characteristic of arteriovenous fistulae that can be identified by color duplex scanning. In this review, we discuss some controversial aspects of the natural history of deep vein thrombosis to provide a better understanding of its course and its impact on venous disease.

scholarly journals Analysis of the Cochrane Review: Thrombolysis for Acute Deep Vein Thrombosis. Cochrane Database Syst Rev. 2014,1: CD002783.

2015 ◽  
Vol 28 (1) ◽  
pp. 12 ◽  
Author(s):  
Liliana Sousa Nanji ◽  
André Torres Cardoso ◽  
João Costa ◽  
António Vaz-Carneiro
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Thrombolytic Therapy ◽  
Bleeding Complications ◽  
Controlled Trials ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Recurrent Deep Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

<p>The standard treatment for acute deep vein thrombosis (DVT) targets to reduce immediate complications, however thrombolysis could reduce the long-term complications of post-thrombotic syndrome in the affected limb. This systematic review aimed to assess the effects of thrombolytic therapy and anticoagulation <em>versus </em>anticoagulation in people with deep vein thrombosis of the lower limb through the effects on pulmonary embolism, recurrent deep vein thrombosis, major bleeding, post-thrombotic complications, venous patency and venous function. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last search in April 2013) and CENTRAL (2013, Issue 4). A total of 17 randomised controlled trials (RCTs) and 1103 participants were included. In the experimental group receiving thrombolysis, complete clot lysis occurred more frequently and there was greater improvement in venous patency. The incidence of post-thrombotic syndrome decreased by a 1/3 and venous ulcers were less frequent. There were more bleeding complications and 3 strokes occurred in less recent studies, yet there seemed to be no significant effect on mortality. Data on the occurrence of pulmonary embolism and recurrent deep vein thrombosis were inconclusive. There are advantages to thrombolysis, yet the application of rigorous criteria is warranted to reduce bleeding complications. Catheter-directed thrombolysis is the current preferred method, as opposed to systemic thrombolysis in the past, and other studies comparing these procedures show that results are similar.</p><p><strong>Keywords:</strong> Randomized Controlled Trials as Topic; Thrombolytic Therapy; Venous Thrombosis.</p>

scholarly journals Warfarin-Induced Spontaneous Bilateral Breast and Extrathoracic Hematoma in an Elderly Woman

2020 ◽  
Author(s):  
Behnam Shakerian ◽  
Negin Razavi
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Rare Disease ◽  
Chest Wall ◽  
Elderly Woman ◽  
Warfarin Therapy ◽  
Vein Thrombosis ◽  
History Of ◽  
Deep Vein

Warfarin- induced spontaneous breast hematoma is a very rare disease, with only a few cases having been reported in the literature so far. We describe an 80-year-old woman who had warfarin therapy due to deep vein thrombosis in a lower extremity. The patient was admitted with a history of swelling and red area on her bilateral breasts, chest wall, right arm, and right flank. She was treated conservatively with success. She was discharged after about 3 weeks without complications and was well at 6 months’ follow-up.

A Negative D-dimer Excludes Recurrent Deep Vein Thrombosis: Results of a Multicentre Management Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 698-698 ◽  
Author(s):  
Shannon Bates ◽  
Clive Kearon ◽  
Susan Kahn ◽  
Jim A. Julian ◽  
Mark A. Crowther ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
High Sensitivity ◽  
Vein Thrombosis ◽  
Recurrent Deep Vein Thrombosis ◽  
Clinically Significant ◽  
Suspected Recurrence ◽  
Lost To Follow Up ◽  
Deep Vein ◽  
D Dimer

Abstract The high frequency of residual radiologic abnormalities after initial deep vein thrombosis (DVT) makes management of patients with suspected recurrence difficult. D-dimer (DD) and serial compression ultrasonography (CUS) of the proximal veins have a high sensitivity and negative predictive value (NPV) in suspected first DVT. We hypothesized that it would be safe to withhold anticoagulation in patients with suspected recurrence who had a negative sensitive DD or negative serial CUS when DD testing was positive. In a multicentre prospective cohort study, patients underwent DD testing with an immunoturbidometric assay (MDA DD). If the DD was negative (<0.5 ug fibrinogen equivalent units [FEU]/mL), patients had no further testing. If the DD was positive, CUS was performed and, if normal, repeated after 1–3 and 7–10 days. Patients with a positive DD and abnormal CUS at presentation were managed as per their treating physician. Patients were followed for 3 months to detect venous thromboembolism (VTE) and suspected VTE were adjudicated centrally. Of the 504 patients enrolled in this study, 14 were subsequently deemed ineligible and 2 patients were lost to follow-up. The overall prevalence of confirmed recurrent DVT at presentation or during follow-up was 17%. 230 patients had a negative DD at presentation and, of the 227 evaluable patients, 4 had definite confirmed VTE (NPV of DD = 98%; 95% Confidence Interval [CI], 96–99%). Of the 135 patients with a positive DD and normal initial CUS, serial CUS was negative in 129 cases. Of these patients, 3 had definite VTE during follow-up (NPV of serial CUS in patients with positive DD = 98%; 95% CI, 93–99%). These results suggest that a negative MDA DD result excludes clinically significant recurrent DVT and that anticoagulants can also be safely withheld in patients with negative serial CUS, even if their DD is positive. This simple diagnostic approach can be used to safely manage approximately 70% of patients with suspected recurrent DVT.

Endovascular management of extensive lower extremity acute deep vein thrombosis with AngioJet rheolytic thrombectomy plus catheter-directed thrombolysis from contralateral femoral access

2018 ◽  
Vol 34 (4) ◽  
pp. 257-265 ◽  
Author(s):  
Guang Liu ◽  
Zhen Zhao ◽  
Chaoyi Cui ◽  
Kaichuang Ye ◽  
Minyi Yin ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Rheolytic Thrombectomy ◽  
Complete Lysis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Purpose The aim of the present study was to report the clinical outcomes of endovascular treatment for extensive lower limb deep vein thrombosis with AngioJet rheolytic thrombectomy (ART) plus catheter-directed thrombolysis (CDT) using a contralateral femoral approach. Methods A retrospective analysis of consecutive ART+CDT treatments in 38 deep vein thrombosis patients (LET I-III, from September 2014 to March 2016) was performed. Results The technical success rate was 100%. Complete lysis was achieved in 82% of LET III segments (calf veins), 87% of LET II segments (popliteal-femoral veins), and 90% of LET III segments (iliac veins). The best results were obtained in patients treated within seven days of symptom onset. During follow-up, well-preserved, competent femoral valves were observed in 86% of the patients, and recanalization of LET III, LET II, and LET I segments was achieved in 100%, 94%, and 91% of the patients, respectively. The post-thrombotic syndrome rate was 17% during a mean 20-month follow-up.

Contralateral deep vein thrombosis after stenting across the iliocaval confluence in chronic venous disease – A systematic review

2019 ◽  
Vol 35 (4) ◽  
pp. 221-230 ◽  
Author(s):  
Luis Duarte-Gamas ◽  
João P Rocha-Neves ◽  
António Pereira-Neves ◽  
Marina Dias-Neto ◽  
Niels Baekgaard
Keyword(s):  
Systematic Review ◽  
Deep Vein Thrombosis ◽  
Iliac Vein ◽  
Venous Disease ◽  
Antithrombotic Treatment ◽  
Vein Thrombosis ◽  
Anticoagulation Treatment ◽  
Post Thrombotic Syndrome ◽  
Deep Vein

Objective Stenting of the iliac veins is increasingly considered in the presence of symptomatic obstructive chronic lesions in the iliac vein segment. However, it is often necessary to extend the stented zone into the inferior vena cava, increasing the risk of contralateral iliac vein thrombosis. This study aims to review the current literature concerning the incidence of contralateral deep vein thrombosis after stenting across the iliocaval confluence. Methods A systematic review from potentially relevant published articles reporting contralateral deep vein thrombosis after iliac venous stenting between January 2007 and February 2019 was performed. Results A total of 764 references were retrieved initially. Twelve studies reporting events of contralateral deep vein thrombosis were selected for review, with a total of 1864 patients. Contralateral deep vein thrombosis incidence varied between 0% and 15.6%. The post-interventional and follow-up anticoagulation regimens were heterogeneous between studies. The decision to maintain patients on anticoagulation and the duration of treatment was based on the presence of comorbidities, hypercoagulable states, post-thrombotic syndrome and history of recurrent deep vein thrombosis. Patients with non-thrombotic iliac vein lesions were either anticoagulated for three or six months after stenting or received no anticoagulation. Patients with post-thrombotic syndrome were anticoagulated for longer periods. Most studies (eight studies) used an oral vitamin K antagonist agent. The data on compliance with anticoagulation treatment is scarce and few references present data on whether contralateral deep vein thrombosis occurred during anticoagulation treatment. The use of antiplatelet agents in addition to the anticoagulant treatment in the follow-up period was also variable. Conclusion The incidence of contralateral deep vein thrombosis due to iliac vein jailing is not negligible and reported being as high as 15.6%. Large-scale studies on the ideal antithrombotic treatment and its impact are necessary. It is possible that patients with stent crossing the iliocaval confluence might benefit from long-term antithrombotic treatment.

scholarly journals Features of etiology and pathogenesis of acute deep vein thrombosis in children of different age groups. Results of a prospective cohort study in parallel groups

2019 ◽  
Vol 100 (3) ◽  
pp. 410-415
Author(s):  
I N Nurmeev ◽  
L M Mirolubov ◽  
L I Batyrshina ◽  
N N Nurmeev ◽  
M R Gilmutdinov ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Age Groups ◽  
First Year ◽  
Predisposing Factor ◽  
Vein Thrombosis ◽  
Venous Catheterization ◽  
History Of ◽  
Acute Deep Vein Thrombosis ◽  
First Year Of Life ◽  
Deep Vein

Aim. To study the characteristics of the etiology and clinical picture of acute deep vein thrombosis in children of different age groups. Methods. The article analyzes the diagnosis and treatment of 77 children and adolescents with acute deep vein thrombosis. The features of the history of patients, previous fact of deep venous catheterization were studied. The fact of the presence and absence of clinical symptoms of thrombosis is registered. The results of ultrasound diagnostics are used. All patients underwent a course of anticoagulant therapy. The results of diagnosis and treatment were evaluated taking into account the age of the patients, the presence/absence of the history of catheterization of deep veins. Results. When comparing different age groups, their distinctive characteristics were revealed: predominant presence of asymptomatic catheter-associated thrombosis in the younger age group (newborns and infants) with symptomatic deep vein thrombosis of various origin in older children. Among the surveyed, the majority (75.3%) had asymptomatic thrombosis. Pain (2.6%), edema (3.9%) and a combination of pain and edema (18.2%) were more common among symptomatic patients with the symptoms of acute vein thrombosis. In some cases, a combination of two or more complaints was noted. Asymptomatic thrombosis in the catheter-associated thrombosis group amounted to 96.6%. All patients below 1 year had a predisposing factor in the history: 95% - preceding vein catheterization, 5% - postoperative period. With a history of venous catheterization, symptoms of thrombosis were detected 9.2 times less frequently than in children without vein catheterization. In the group of children older than a year, the ratio of thrombosis without a predisposing factor was 10.5%, and the ratio of children with symptoms of thrombosis was 1.38 times higher than among children younger than a year. The only fatal outcome: a 17-year-old patient with a history of thrombophilia, thrombosis of the left iliac vein, pulmonary embolism. Conclusion. Deep vein thrombosis in children of the first year of life in all cases was caused by a predisposing factor: in children during the first year of life in 95% of cases deep vein thrombosis was asymptomatic and was revealed by ultrasound examination.

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