scholarly journals Should we diagnose and treat distal deep vein thrombosis?

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 231-236 ◽  
Author(s):  
Helia Robert-Ebadi ◽  
Marc Righini
Keyword(s):  
Deep Vein Thrombosis ◽  
Statistical Power ◽  
Medical Condition ◽  
Low Risk ◽  
Vein Thrombosis ◽  
Randomized Studies ◽  
Therapeutic Anticoagulation ◽  
Risk Patients ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

Abstract Ultrasound series report that isolated distal deep vein thrombosis (DVT), also known as calf DVT, represents up to 50% of all lower-limb DVTs and, therefore, is a frequent medical condition. Unlike proximal DVT and pulmonary embolism, which have been studied extensively and for which management is well standardized, much less is known about the optimal management of isolated calf DVT. Recent data arising from registries and nonrandomized studies have suggested that most distal DVTs do not extend to the proximal veins and have an uneventful follow-up when left untreated. These data had some impact on the international recommendations that recently stated that ultrasound surveillance instead of systematic therapeutic anticoagulation might be an option for selected low-risk patients. However, robust data from randomized studies are scarce. Only 5 randomized trials assessing the need for anticoagulation for calf DVT have been published. Many of these trials had an open-label design and were affected by methodological limitations. The only randomized placebo-controlled trial included low-risk patients (outpatients without cancer or previous venous thromboembolism [VTE]) and was hampered by limited statistical power. Nevertheless, data from this trial confirmed that the use of therapeutic anticoagulation in low-risk patients with symptomatic calf DVT is not superior to placebo in reducing VTE but is associated with a significantly higher risk of bleeding. Further randomized studies are needed to define the best therapy for high-risk patients (inpatients, patients with active cancer, or patients with previous VTE) and the optimal dose and duration of treatment.

Prospective 12-Year Follow-up Study of Clinical and Hemodynamic Sequelae After Deep Vein Thrombosis in Low-Risk Patients (Zürich Study)

Circulation ◽  
1996 ◽  
Vol 93 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Ulrich K. Franzeck ◽  
Ilse Schalch ◽  
Kurt A. Jäger ◽  
Ernst Schneider ◽  
Jörg Grimm ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Low Risk ◽  
Vein Thrombosis ◽  
Follow Up Study ◽  
Risk Patients ◽  
Deep Vein

scholarly journals Prevalence of Deep Vein Thrombosis in Low Risk Patients After Elective Foot and Ankle Surgery

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0000
Author(s):  
Martin Sullivan ◽  
Christopher Kreulen ◽  
Ilian Dominiq Eusebio ◽  
Jacqueline Hang ◽  
Abdul Omari
Keyword(s):  
Deep Vein Thrombosis ◽  
High Resolution ◽  
Late Onset ◽  
Weight Bearing ◽  
Low Risk ◽  
True Incidence ◽  
Vein Thrombosis ◽  
Ankle Surgery ◽  
Risk Patients ◽  
Deep Vein

Category: Surgical complications Introduction/Purpose: For patients undergoing elective foot or ankle surgery deep vein thrombosis is a recognised risk with morbidity.The literature is often based on a retrospective review of the clinical notes which can be misleading. Surveillance has not been done in the past .Our concern was that the true incidence of DVT may have been underreported and silent DVTs are possible . The study prospectively determines the prevalence of DVT in low risk patients who are non weight bearing for 6 weeks post operatively by having patients undergo clinical detection as well as high resolution ultrasound to determine the presence and extent of deep vein thrombosis (DVT) in the patients operated leg at 2 weeks and 6 weeks after surgery. Methods: 197 patients undergoing elective (i.e. not trauma or achilles ruptures) foot or ankle surgery requiring a period of 6 weeks non weight bearing post operatively were selected for the study over a 2 year period. 83 patients were excluded as being high risk for DVT based on recognised criteria. The remaining 114 patients were included in the study as they were low risk for DVT. All 114 patients were assessed clinically at 2 weeks and 6 weeks post op for the possibility of DVT and this was recorded.The patients were then sent for high resolution U/S scans on the affected leg at 2 and 6 weeks after the surgery . A middle frequency (4-9 MHz) transducer was used for the study, and a lower frequency transducer for obese or swollen legs. The scans were performed at the Vascular Lab at our Institution which performs over 10000 scans annually. Results: 114 patients were in the study. 71 Females and 43 males with average age 52 years . The incidence of DVT was 24.56% (28/114). Of the 28 positive scans, 22 (79%) had no clinical symptoms or signs of DVT. 20/28 (71%) DVTs were diagnosed at the 2 week scan and 15 of these had no symptoms or signs of DVT. 8/28 (29%) patients had clear scans at 2 weeks and positive scans at 6 weeks.In this late onset group 7/8 had no symptoms or signs of a DVT. Only 5% (6/114) patients had symptoms or signs of DVT. The incidence of DVT in the first 2 weeks after surgery was 17.5%. Of the remaining 94 patients, 8.5% developed a DVT after 2 weeks. Conclusion: In low risk patients who are non weight bearing for 6 weeks after elective foot or ankle surgery the prevalence of DVT (25%) is significantly higher than the literature suggests and the majority of patients 79% (22/28) had no symptoms or signs of DVT to assist in the diagnosis. The majority of DVT’s occurred in the first 2 weeks after surgery however 29% of the total number of DVTs occurred between week 3 and week 6 non weight bearing.

Outcome of Anticoagulation in Isolated Distal Deep Vein Thrombosis Compared to Proximal Deep Venous Thrombosis

2021 ◽  
Author(s):  
Danielle T Vlazny ◽  
Ahmed K Pasha ◽  
Wiktoria Kuczmik ◽  
Waldemar E Wysokinski ◽  
Matthew Bartlett ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

Deep Vein Thrombosis Prophylaxis: Audit of Practice in General Surgical Patients in a Teaching Hospital

2000 ◽  
Vol 15 (2) ◽  
pp. 71-74 ◽  
Author(s):  
O. Agu ◽  
A. Handa ◽  
G Hamilton ◽  
D. M. Baker
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Teaching Hospital ◽  
Surgical Patients ◽  
Thrombosis Prophylaxis ◽  
High Risk Patients ◽  
Vein Thrombosis ◽  
Dvt Prophylaxis ◽  
Risk Patients ◽  
Deep Vein

Objective: To audit the prescription and implementation of deep vein thrombosis (DVT) prophylaxis in general surgical patients in a teaching hospital. Methods: All inpatients on three general surgical wards were audited for adequacy of prescription and implementation prophylaxis (audit A). A repeat audit 3 months later (audit B) closed the loop. The groups were compared using the chi-square test. Results: In audit A 50 patients participated. Prophylaxis was correctly prescribed in 36 (72%) and implemented in 30 (60%) patients. Eighteen patients at moderate or high risk (45%) received inadequate prophylaxis. Emergency admission, pre-operative stay and inadequate risk assignment were associated with poor implementation of protocol. In audit B 51 patients participated. Prescription was appropriate in 45 (88%) and implementation in 40 (78%) patients (p< 0.05). Eleven patients at moderate or high risk received inadequate prophylaxis. Seven of 11 high-risk patients in audit A (64%) received adequate prophylaxis, in contrast to all high-risk patients in audit B. The decision not to administer prophylaxis was deemed appropriate in 5 of 15 (30%) in audit A compared with 6 of 10 (60%) in audit B. Conclusion: Increased awareness, adequate risk assessment, updating of protocols and consistent reminders to staff and patients may improve implementation of DVT prophylaxis.

Rivaroxaban for the Treatment of Symptomatic Isolated Distal Deep Vein Thrombosis – RIDTS Study

2021 ◽  
Author(s):  
Walter Ageno ◽  
Lorenza Bertù ◽  
Eugenio Bucherini ◽  
Giuseppe Camporese ◽  
Francesco Dentali ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

scholarly journals Management of isolated distal deep vein thrombosis. A persistent conundrum?

2020 ◽  
Vol 26 (2) ◽  
pp. 65-71
Author(s):  
Nalaka Gunawansa ◽  
Thilina Gunawardena
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

scholarly journals THE ASSOCIATION BETWEEN D-DIMER AND DEEP VEIN THROMBOSIS LOCATION AND ITS ABILITY TO PREDICT PULMONARY EMBOLISM, a retrospective pilot study

2019 ◽  
Author(s):  
Sarah Ali Althomali ◽  
Adel S. Alghamdi ◽  
Tareef H. Gnoot ◽  
Mohammad A. Alhassan ◽  
Abdullatif H. Ajaimi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Risk Group ◽  
Great Role ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Risk Patients ◽  
Deep Vein ◽  
Limb Deep Vein Thrombosis ◽  
D Dimer

Abstract Background In lower limb deep vein thrombosis; it is important to identify proximal from distal deep vein thrombosis as it carries the highest risk of pulmonary embolism. It is known that D-dimer has a great role in deep vein thrombosis diagnosis. Yet, the use of D-dimer to predict the location of deep vein thrombosis and the risk of pulmonary embolism in deep vein thrombosis patients has not been investigated before. Objective To address the correlation between D-dimer and the location of deep vein thrombosis and to study the efficacy of D-dimer to predict risk of PE in patients with proximal or extensive deep vein thrombosis. Method We included 110 consecutive patients who were hospitalized with the diagnosis of deep vein thrombosis, with or without a concomitant diagnosis of PE, and with D-dimer measured at initial presentation. We categorized the location of deep vein thrombosis as: distal, proximal, and extensive. In the analysis, patients were grouped into high-risk (patients with Proximal or Extensive deep vein thrombosis and pulmonary embolism) and low risk group (patients without pulmonary embolism). Results There was no significant association between D-dimer level and the location of deep vein thrombosis (p=0.519). However, D-dimer level was greater among patients with pulmonary embolism (9.6mg/L) than among patients without pulmonary embolism (7.4mg/L), (p=0.027). D-dimer was a significant predictor of pulmonary embolism as patients with proximal or extensive deep vein thrombosis had 8-folds increased risk of pulmonary embolism than patients with D-dimer less than 4.75mg/L (OR=7.9, p=0.013). Conclusion Though D-dimer was not significantly associated with the location of deep vein thrombosis, it was a significant predictor of pulmonary embolism in patients hospitalized with proximal or extensive deep vein thrombosis.

Significance and management of isolated distal deep vein thrombosis

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ilia Makedonov ◽  
Jean-Philippe Galanaud ◽  
Susan R. Kahn
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein
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