Occult malignancy in patients with venous thromboembolism: risk indicators and a diagnostic screening strategy

2007 ◽  
Vol 22 (2) ◽  
pp. 75-79 ◽  
Author(s):  
G L Oktar ◽  
E G Ergul ◽  
U Kiziltepe
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Screening Strategy ◽  
Risk Indicators ◽  
Diagnostic Screening ◽  
X Ray ◽  
Underlying Malignancy ◽  
Occult Malignancy ◽  
Chest X Ray

Background: The study was designed to analyse the risk indicators for a possible underlying malignancy and to evaluate whether extensive cancer screening is necessary in all patients with venous thromboembolism or not. Methods: In total, 126 patients with idiopathic deep venous thrombosis, and 121 patients with secondary deep venous thrombosis of lower extremity and without a known malignancy were studied. A diagnostic screening workup including a clinical history, physical examination, complete blood count, blood sedimentation rate, basic biochemistry panel including hepatic and renal function tests, prostate-specific antigen, a chest X-ray and an abdominopelvic ultrasonography was performed for all patients. Results: Suspicious findings suggesting an underlying cancer, previous history of venous thromboembolism, bilateral venous thrombosis and associated thrombosis in unusual sites were significantly more common in patients with idiopathic venous thrombosis. A malignancy was detected in 10 of the 126 patients (7.9%) without a known risk factor for deep venous thrombosis. During the follow-up period, a diagnosis of malignancy was established in two patients in the same group. Conclusion: The risk of an underlying malignancy in patients with idiopathic venous thromboembolism is significantly higher. A moderate screening strategy has the capacity to identify the majority of the malignancies in such patients. We advocate simple laboratory tests, a chest X-ray and an abdominopelvic ultrasonography in order to search for an occult malignancy. A more extensive screening strategy may be considered for patients with suspicious findings for cancer, recurrent or bilateral venous thromboembolism and associated thrombosis in unusual sites.

Deep Venous Thrombosis of the Legs after Strokes: Incidence, Natural History and Predisposing Factors

1975 ◽  
Author(s):  
Charles Warlow ◽  
D. Ogston ◽  
A. S. Douglas
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Past History ◽  
Cerebrovascular Accidents ◽  
X Ray ◽  
Clinical Criteria ◽  
Vein Thrombosis ◽  
History Of ◽  
Chest X Ray

Forty of 76 patients who had sustained a cerebro-vascular’ accident developed a deep venous thrombosis of the paralysed leg as detected by the 125I-fibrinogen technique. A further 5 also had a thrombosis in the non-paralysed leg. ‘Definite’ pulmonary embolism, diagnosed at necropsy or by unequivocal clinical criteria, occurred in 9.2% of patients and ‘probable’ embolism, diagnosed on clinical examination and chest x-ray only, occurred in another 6.6% of patients Within the limitations of the 125I-fibrinogen technique it appeared that, in patients after cerebrovascular accidents, thrombosis developed in several independent sites in the venous system of the legs and propagation of the thrombi took place in both a distal and proximal direction. Pulmonary embolism occurred, with one exception, only in patients with detectable leg vein thrombosis.None of the risk factors studied including age, sex, obesity, side of paralysis, past history of venous thromboembolism, neurological and cardiac states, and interval between onset of stroke and mobilisation was helpful in predicting the likelihood of development of venous thrombosis in the paralysed limb.

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

Vascular ◽  
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.

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

1999 ◽  
Vol 82 (10) ◽  
pp. 1222-1226 ◽  
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.

Venous Thromboembolism Prophylaxis in Aesthetic Surgery: A Survey of Plastic Surgeons’ Practices

2020 ◽  
Vol 40 (12) ◽  
pp. 1351-1369 ◽  
Author(s):  
Victoria L Aimé ◽  
Matthew R Neville ◽  
Danielle A Thornburg ◽  
Shelley S Noland ◽  
Raman C Mahabir ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Assessment Tool ◽  
Aesthetic Surgery ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Electronic Survey ◽  
The Aesthetic

Abstract Background Deep venous thrombosis and pulmonary embolism, collectively known as venous thromboembolism (VTE), are among the most feared yet preventable surgical complications. Although many recommendations exist to reduce the risk of VTE, the actual VTE prophylaxis practices of aesthetic plastic surgeons remain unknown. Objectives The primary aim of this study was to elucidate plastic surgeons’ experiences with VTE, preferred VTE prophylaxis practices, and areas in which VTE prevention may be improved. Methods Members of The Aesthetic Society were queried via a 55-question electronic survey regarding their experience with VTE as well as their VTE prophylaxis practices. Anonymous responses were collected and analyzed by the Mayo Clinic Survey Research Center. Results The survey was sent to 1729 of The Aesthetic Society members, of whom 286 responded. Fifty percent, 38%, and 6% of respondents reported having had a patient develop a deep venous thrombosis, pulmonary embolism, or death secondary to VTE, respectively. Procedures performed on the back or trunk were associated with the highest rate of VTE. Lower extremity procedures were associated with a significantly higher rate of VTE than expected. Over 90% of respondents reported utilizing a patient risk stratification assessment tool. Although at least one-half of respondents reported that the surgical facility in which they operate maintains some form of VTE prophylaxis protocol, 39% self-reported nonadherence with these protocols. Conclusions Considerable variability exists in VTE prophylaxis practices among The Aesthetic Society responders. Future efforts should simplify guidelines and tailor prophylaxis recommendations to the aesthetic surgery population. Furthermore, education of plastic surgeons performing aesthetic surgery and more diligent surgical venue supervision is needed to narrow the gap between current recommendations and actual practices.

Venous thromboembolism: epidemiology and aetiology

2016 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis

Venous thromboembolism denotes pulmonary embolism and deep venous thrombosis. This chapter addresses the epidemiology and aetiology of the disease.

scholarly journals Screening for Occult Cancer in Patients with Venous Thromboembolism

2020 ◽  
Vol 9 (8) ◽  
pp. 2389
Author(s):  
Julien D’Astous ◽  
Marc Carrier
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Screening ◽  
Cancer Detection ◽  
Complete Blood Count ◽  
Liver Function Tests ◽  
Screening Strategy ◽  
Mortality And Morbidity ◽  
Occult Cancer ◽  
Chest X Ray ◽  
And Gender

Unprovoked venous thromboembolism (VTE) can be the first sign of an occult cancer. The rate of occult cancer detection within 12 months of a newly diagnosed unprovoked VTE is approximately 5%. Therefore, it is appealing for clinicians to screen patients with unprovoked VTE for occult cancer, as it could potentially decrease cancer-related mortality and morbidity and improve quality of life. However, several randomized controlled trials have failed to report that an extensive occult cancer screening strategy (e.g., computed tomography of the abdomen/pelvis) is improving these patient-important outcomes. Therefore, clinical guidance documents suggest that patients should only undergo a limited screening strategy including a thorough medical history, physical examination, basic laboratory investigations (i.e., complete blood count and liver function tests), chest X-ray, as well as age- and gender-specific cancer screening (breast, cervical, colon and prostate). More intensive occult cancer screening including additional investigations is not routinely recommended. This narrative review will focus on the epidemiology, timing, and evidence regarding occult cancer detection in patients with unprovoked VTE.

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