In Well-Selected Patients With a Femoral Deep Vein Thrombosis Central Venous Imaging May Identify Additional Iliocaval Disease

Objective: Patients who present acutely with a femoral deep vein thrombosis (DVT) diagnosed by ultrasound are often treated with anticoagulation and instructed to follow-up electively. This study sought to assess whether obtaining axial imaging of the central venous system results in the identification of additional iliocaval pathology warranting treatment. Methods: This study was a retrospective review of a prospectively maintained registry from November 2014 through April 2017 with follow-up through March 2020. Consecutive patients with a diagnosis of femoral DVT diagnosed by ultrasound were evaluated; those who underwent axial imaging of the iliocaval system (Group A) were compared to those who did not undergo imaging of the central veins (Group B). The primary outcome was the performance of any percutaneous central venous intervention. Secondary outcomes included the extent of DVT identified on duplex and after axial imaging, follow-up duplex patency and persistence of severe symptoms. Results: Eighty patients presented with an ultrasound diagnosis of a femoral vein DVT. Mean follow-up was 551 ± 502 days. Group A comprised 24 patients (30%) and Group B comprised 56 patients (70%). Baseline demographics did not differ significantly between the 2 groups. After duplex imaging, Group A exhibited an increased prevalence of DVT in the common femoral vein. After central imaging, Group A exhibited an increased prevalence of DVT in the iliocaval veins. The number of patients who underwent invasive treatment differed significantly between the 2 groups, Group A 16/24 (67%) vs. Group B 9/56 (16%), P < 0.0001. The number of patients that demonstrated duplex patency and had persistent symptoms on follow-up did not differ significantly. Conclusions: Patients with an ultrasound diagnosis of femoral DVT may have additional iliocaval pathology warranting intervention. Well-selected imaging of the central veins may reveal a more complete picture, potentially altering management.

Download Full-text

Residual Vein Thrombosis Improves Screening for Occult Cancer: Results On 537 Patients with Idiopathic Deep Vein Thrombosis.

Blood ◽

10.1182/blood.v114.22.3999.3999 ◽

2009 ◽

Vol 114 (22) ◽

pp. 3999-3999

Author(s):

Sergio Siragusa ◽

Alessandra Malato ◽

Fabio Fulfaro ◽

Giorgia Saccullo ◽

Domenica Caramazza ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Early Detection ◽

Lower Limbs ◽

Vein Thrombosis ◽

Occult Cancer ◽

Group A ◽

Group B ◽

Deep Vein ◽

Related Mortality

Abstract Abstract 3999 Poster Board III-935 Background Clinical advantage of extensive screening for occult cancer in patients with idiopathic Deep Vein Thrombosis (DVT) is unknown. We have demonstrated that the Residual Vein Thrombosis (RVT)-based screening for occult cancer improves early detection as well as cancer-related mortality (Siragusa S et al. Blood 2007;110(699):OC). Here we report on final analysis of 537 patients over a period of 8 years. Objective of the study We conducted a prospective study evaluating whether a RVT-based screening for cancer is sensitive and influences cancer-related mortality. Study design Prospective with two cohorts of DVT patients: the first cohort was monitored for clinical overt cancer only (Group A), while the second (Group B) received complete screening for occult neoplasm and subsequent surveillance. Materials and methods Consecutive patients with a first episode of DVT who presented RVT after 3 month of anticoagulation and without signs and/or symptoms for overt cancer. Screening for occult cancer was based on: ultrasound and/or CT scan of the abdomen and pelvis, gastroscopy, colonoscopy or sigmoidoscopy, hemoccult, sputum cytology and tumor markers. These tests were extended with mammography and Pap smear for women and ultrasound of the prostate and total specific prostatic antigen (PSA) for men. All investigations had to be completed within four-weeks from the assessment of RVT. All patients were followed-up for at least 2 years. Incidence and cancer-related mortality was compared between the two groups by survival curves (Kaplan-Mayer) and related Breslow test for statistics. Results Over a period of 8 years, 537 patients were included in the analysis: first cohort included 346 patients (Group A), second cohort 191 (Group B). Clinical characteristics between groups were homogenous. During the follow-up, 8.3% of patients developed overt cancer in group A; in group B, 7.8% of patients had diagnosed cancer at the moment of extensive screening while 2 new cases (0.7%) occurred during the follow-up (Table). The sensitivity of this approach was 92.1% (95% confidence intervals 75.2-104.2). Cancer-related mortality was 7.5% in group A and 3.6% in group B (p< 0.001). Conclusions The RVT-based screening for occult cancer is highly effective for improving early detection as well as cancer-related mortality in a cohort of 537 patient with DVT of the lower limbs. Disclosures: Off Label Use: Hydroxyurea use in myelofibrosis.

Download Full-text

Residual Vein Thrombosis for Assessing the Optimal Management of Deep Vein Thrombosis in Cancer Patients: An Interim Analysis of the Cancer DACUS Study.

Blood ◽

10.1182/blood.v112.11.985.985 ◽

2008 ◽

Vol 112 (11) ◽

pp. 985-985 ◽

Cited By ~ 1

Author(s):

Sergio Siragusa

Keyword(s):

Deep Vein Thrombosis ◽

Cancer Patients ◽

Major Bleeding ◽

Recurrent Events ◽

P Value ◽

Vein Thrombosis ◽

Group A ◽

Group B ◽

Deep Vein

Type and duration of anticoagulation is still matter of debate in cancer patients with acute Deep Vein Thrombosis (DVT) of the lower limbs. Residual Vein Thrombosis (RVT) has been proven to be effective for assessing the optimal duration of oral anticoagulants in non cancer patients (Siragusa S et al Blood2008:112:511-5). In the present study we evaluate the role of a RVT-based management of anticoagulation with Low-Molecular Weight Heparin in cancer patients with acute DVT. Materials and Methods. Cancer patients with a first episode of DVT were treated with LMWH at therapeutic dosage for 1 month followed by dose reduction of 25% in the next 5 months. At this time, they were managed according to RVT findings: those with RVT were randomized to continue anticoagulants for 6 additional months (Group A1) or to stop (Group A2), while patients without RVT stopped LMWH (Group B). Outcomes were recurrent venous thromboembolism and/or major bleeding. Results. Over a period of 18 months, 134 patients were evaluated across 12 centers in Italy; clinical characteristics and duration of follow-up are reported in the Table 1. RVT was detected in 92 (68.6%) patients; recurrent events occurred in 23.4% of those who discontinued and 15.5% of those who continued LMWH (Table 2 and Figure 1). The adjusted Hazard Ratio (HR) for age and sex (Group A2 vs A1) was 1.58 (95% confidence interval [CI], 0.85–2.93; P = .145). Of the 42 (31.3%) patients without RVT, one had a recurrence (2.3%) (Table 2 and Figure 1). The adjusted HR (B vs A1) was 4.54 (CI 2.3–6.66; P =.028). One major bleeding event occurred in each group of patients who stopped (Group A2 and B) and 2 in those who continued anticoagulation (Table 2). Overall, 31 (23.1%) patients died due to cancer progression after a median follow-up of 13.2 months after randomization. Conclusions. The Cancer DACUS is the first study evaluating an individual marker for assessing duration of anticoagulation in active cancer population. This interim analysis shows that absence of RVT identifies a group of patients at low risk for recurrent thrombosis who can safely stop LMWH after 6 months. Figure 1. Kaplan-Meyer curve for recurrent events among groups Figure 1. Kaplan-Meyer curve for recurrent events among groups Table 1. Baseline patients characteristics Group A 1 (n.45) Group A 2 (n.47) Group B (n.42) P value* *P value refers to chi-squared test unless specified. ^Time from randomization (6 months after the index Deep Vein Thrombosis) #Active cancer at the time of diagnosis Female sex (%) 22 (48.8) 23 (48.9) 20 (47.6) 0.999 Age, mean + SD (y) 58.2 ± 12.2 63.7 ± 11.1 57.8 ± 11.6 0.124 Total duration of follow-up, (y)^ 31.5 32.8 29.9 0.146 Mean follow-up, (y)^ 1.2 ± 0.56 1.1 ± 0.53 1.1 ± 0.60 0.156 #Type of cancer: Gastrointestinal, n (%) 16 (35.5) 18 (38.3) 16 (38) 0.32 Genitourinary, n (%) 9 (20) 7 8 (17) 7 (16.6) 0.23 Breast, n (%) (15.5) 8 6 (12.7) 6 (14.2) 0.45 Lung, n (%) (17.7) 5 10 (21.2) 10 (23.8) 0.32 Haematologic, n (%) (11.1) 5 (10.6) 6 (14.2) 0.67 Table 2. Study Outcomes Outcomes Group A 1 (n.45) Group A 2 (n.47) Group B (n.42) P value* * P value refers to chi-squared test unless specified. ** P value refers to Fisher exact test 0.021 0.030 A1 vs B** Recurrences, n/total (%) 7/45 (15.5) 11/47(23.4) 1/42 (2.3) 0.010 A2 vs B** 0.733 A1 vs A2** Recurrences, n/100 person-year (%) 7/34.75 (20.1) 11/40.33 (27.3) 1/38.92 (2.5) 0.008 Type of recurrent VTE DVT 5 8 1 DVT + PE 2 2 0 Isolated PE 0 1 0 Subtype Controlateral 1 2 1 Major bleeding, n/total (%) 2/45 (4.4) 1/47(2.1) 1/42(2.3) 0.054** Major bleeding n/100 person-yr(%) 2/40.17 (4.9) 1/46.83 (2.1) 1/36.75 (2.7) 0.390

Download Full-text

Advantages of a Sequential Compression Device in Prevention of Deep Vein Thrombosis

10.1055/s-0039-1684785 ◽

1979 ◽

Author(s):

A.N. Nicolaides ◽

J. Fernandas ◽

A.V. Pollock

Keyword(s):

Deep Vein Thrombosis ◽

Femoral Vein ◽

Test Group ◽

Heparin Group ◽

Similar Time ◽

Vein Thrombosis ◽

Compression Device ◽

Fibrinogen Test ◽

Group B ◽

Deep Vein

A sequential compression device (SCD) (6 chambers) compressing the ankle, calf end thigh sequentially at 35, 30 and 20 mm Hg for 12 seconds in every minute produced a 240% increase in peak velocity in the femoral vein. A non-sequential device (NSD) inflated to 25 mm Hg with a similar time cycle produced only an 180% increase in blood velocity.The two devices were tested clinically; 250 surgical patients were randomised to 3 groups scanned with the 125 I-fibrinogen test. Group A: 7 days subcutaneous heparin. Group B: NSD for 24 hours. Group C: SCD for 24 hours. The SCD was found to be as effective as heparin during the period it was used and more effective than NSD in preventing deep vein thrombosis proximal to the calf.

Download Full-text

Adjusted Versus Fixed Doses of the Low-Molecular-Weight Heparin Fragmin in the Treatment of Deep Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1642507 ◽

1994 ◽

Vol 71 (05) ◽

pp. 698-702 ◽

Cited By ~ 57

Author(s):

M Alhenc-Gelas ◽

C Jestin-Le Guernic ◽

J F Vitoux ◽

A Kher ◽

M Aiach ◽

...

Keyword(s):

Molecular Weight ◽

Deep Vein Thrombosis ◽

Low Molecular Weight Heparin ◽

Factor Xa ◽

Heparin Therapy ◽

Low Molecular Weight ◽

Vein Thrombosis ◽

Group A ◽

Group B ◽

Deep Vein

SummaryTreatment monitoring based on a laboratory parameter increases the efficacy and safety of standard heparin therapy, but it is not known if this also applies to low-molecular-weight heparin (LMWH) therapy of acute deep vein thrombosis (DVT). In a prospective randomized trial involving 122 consecutive patients, group A (58 patients) received a weight adjusted dose of Fragmin (100 IU/kg) subcutaneously twice a day throughout the treatment period (10 days ± 1), while in group B (64 patients) the dosage was based on the results of an anti factor Xa (anti Xa) amidolytic assay to obtain a target concentration from 0.5 to 1 IU/ml. AntiXa and antithrombin activities were also measured retrospectively on frozen plasma from all patients. The two regimens were comparable in terms of hemorrhagic complications (4 in group A and 3 in group B). Bilateral ascending phlebography was performed before inclusion and at the end of LMWH treatment. Treatment efficacy, based on Marder’s score, did not differ between the two groups (p = 0.3). Dosage adjustment to between 0.5 to 1IU anti-Xa/ml does not therefore appear to improve the efficacy or safety of LMWH tieatment. However, correlations between the change in Marder’s score and both anti-Xa (p <0.001) and antithrombin activity (p <0.001) were observed, suggesting a relationship between the degree of FXa or thrombin inhibition and antithrombotic activity.

Download Full-text

Surgery and Environmental Influence as Risk-Factors for the Development of Deep Vein Thrombosis in Animal Experiments

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649655 ◽

1993 ◽

Vol 70 (04) ◽

pp. 712-716 ◽

Cited By ~ 4

Author(s):

R Hoffmann ◽

R C Schimmer ◽

F Largiadèr

Keyword(s):

Deep Vein Thrombosis ◽

Environmental Influence ◽

Animal Experiments ◽

Air Pressure ◽

Control Group ◽

Vein Thrombosis ◽

Group A ◽

The Difference ◽

Group B ◽

Deep Vein

SummaryThe aim of this experimental study was to determine whether deep vein thrombosis (DVT) in animals occurs after osteosynthesis of the femur, and whether a postoperative drop in air pressure increases the frequence of DVT Thus, osteosynthesis of the femur was performed in 10 New Zealand rabbits. Postoperatively a drop in air pressure of 300 hPA was induced. After 40 h in the pressure cabin ascending phlebography was performed (Group A). In a control-group of 10 other rabbits surgery was performed without postoperative drop in air pressure (Group B) while in a second control only the drop in air pressure was induced without surgery (Group C).The phlebographic studies showed DVT in 4 out of 10 rabbits in group A. In group B there was no demonstrable DVT while in group C one ease of DVT was seen. The difference between group A and group B and C is statistically significant. In conclusion, a rapid drop in air pressure seems to have significant impact on the pathogenesis of DVT in rabbits after osteosynthesis of the femur.

Download Full-text

Treatment of Acute Iliofemoral Deep Vein Thrombosis; Does Catheter Directed Thrombolytic Therapy Change Outcomes?

Cardiology Open Access ◽

10.33140/coa.04.03.01 ◽

2019 ◽

Vol 4 (3) ◽

Keyword(s):

Quality Of Life ◽

Deep Vein Thrombosis ◽

Iliac Vein ◽

P Value ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Group A ◽

Deep Vein

Background: Iliofemoral deep vein thrombosis (DVT) is associated with severe post-thrombotic morbidity when treated with anticoagulation alone. Catheter- directed thrombolysis (CDT) allows early removal of thrombus and reduces valvular reflux and Post-thrombotic Syndrome (PTS). Patients and methods: This prospective randomized multi-center controlled two- arm blind study was conducted in 6 centers on 252 patients with iliofemoral DVT. Patients were randomly allocated by using simple random allocation cards method into two groups; Group (A): CDT followed by oral anticoagulation (N=126 (50%)), Group (B): Standard DVT therapy (N=126 (50%)). Follow-up was for 24 months. Results: Patients of group (A) significantly complained less pain at 10 & 30 days (P-Value: 0.02 & 0.04 respectively). Also there was significant decrease in leg circumference in group (A) at 10 & 30 days (P-Value: 0.001 & 0.03 respectively). Patency of iliac vein segment was significantly higher in group (A) during the 24 months follow up (P-Value <0.001 (HS)). Patients in group (A) developed less PTS at six months, at one year and at two years (P-Value: 0.024, 0.017 and 0.035 respectively). Better Quality of life was observed in group (A) (P-Value: 0.003). Conclusion: Addition of catheter-directed thrombolysis in the treatment of acute iliofemoral DVT; was safe and tolerated by most of the patients with better effect to reduce leg pain & circumference. It was considered a protecting weapon to prevent post-thrombotic syndrome and so improve quality of life and was related to achievement of higher iliac vein patency and less reflux.

Download Full-text

Low-molecular-weight heparin in the acute and long-term treatment of deep vein thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613574 ◽

2003 ◽

Vol 89 (04) ◽

pp. 674-680 ◽

Cited By ~ 61

Author(s):

Milena Gebska ◽

Zbigniew Kadziola ◽

Neelam Saba ◽

Pilar Carrasco ◽

Vijay Kakkar ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Term Treatment ◽

Low Molecular Weight ◽

Once Daily ◽

Vein Thrombosis ◽

Long Term Treatment ◽

Group A ◽

Group B ◽

Deep Vein

SummaryLow molecular weight heparins (LMWHs) are frequently used during acute treatment of deep vein thrombosis, but their utility for long-term treatment needs to be defined.In this multi-centre trial, 378 patients with acute deep vein thrombosis were randomised to intravenous unfractionated heparin (group A), once daily subcutaneous LMWH (bemiparin) for one week (group B) or once daily bemiparin in a therapeutic dose for one week followed by a maintenance dose for 12 weeks (group C).Fifty-two per cent of patients in group A, 72% of group B and 72% of group C showed venographic reduction in thrombus size assessed objectively on day 14; 20% greater improvement in group B and C indicates not only non-inferiority of bemiparin (p = 0.00003) but also superiority (p = 0.004) compared to UFH. Day 84 venographic or Doppler sonographic recanalisation of the affected veins was demonstrated in 75.3%, 79.8% and 81.5% in groups A, B and C respectively. Mortality, recurrent thromboembolic events and bleeding were similar in the three groups.Both bemiparin regimens were more effective than UFH in reducing thrombus size during the acute phase of treatment. The efficacy in terms of recurrence of venous thromboembolism and safety of Bemiparin is similar to UFH. Bemiparin is also an effective alternative to warfarin for long-term treatment.

Download Full-text