Unusual deep vein thrombosis sites: magnetic resonance venography in patients with negative compression ultrasound and symptomatic pulmonary embolism

2012 ◽  
Vol 29 (1) ◽  
pp. 25-29 ◽  
Author(s):  
T Gary ◽  
K Steidl ◽  
K Belaj ◽  
F Hafner ◽  
H Froehlich ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Magnetic Resonance ◽  
Venous Thrombosis ◽  
Lower Limbs ◽  
Mr Venography ◽  
Vein Thrombosis ◽  
Compression Ultrasound ◽  
Deep Vein

Objectives To evaluate the clinical characteristics of patients with pulmonary embolism (PE), negative compression ultrasound (CUS) of the lower limbs and detection of unusual deep vein thrombosis (DVT) sites by means of magnetic resonance (MR) venography. Methods A retrospective data analysis of PE patients hospitalized at our institution from April 2009 to 2011. Results From April 2009 to 2011, a total of 762 PE patients were treated at our institution. In 169 of these patients CUS for DVT was negative. In these patients MR venography was performed for further evaluation. We found venous thrombosis at unusual sites in 12 of these patients. Due to free floating thrombus masses and fear of life-threatening PE progression we inserted an inferior vena cava filter in three of these 12 patients. The leading venous thromboembolism risk factor in our patients was immobilization (5 patients, 41.7%). Conclusions We conclude that especially in patients with PE and negative CUS of the lower limbs a thrombosis of the pelvic veins should be considered in case of symptoms for venous thrombosis in this area. Further diagnostic work-up with MR venography should be scheduled in these patients especially in patients with risk factor immobilization as therapeutic consequences might occur.

scholarly journals Prothrombotic Fibrin Clot Phenotype in Patients with Deep Vein Thrombosis and Pulmonary Embolism: A New Risk Factor for Recurrence

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Anetta Undas
Keyword(s):  
Pulmonary Embolism ◽  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Fibrin Clot ◽  
Clot Lysis ◽  
Postthrombotic Syndrome ◽  
Vein Thrombosis ◽  
And Function ◽  
Deep Vein

Prothrombotic fibrin clot phenotype, involving faster formation of dense meshwork composed of thinner and highly branched fibers that are relatively resistant to plasmin-induced lysis, has been reported in patients with not only myocardial infarction or stroke, but also venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT), and/or pulmonary embolism (PE). Prothrombotic fibrin clot phenotype, in particular prolonged clot lysis time, is considered a novel risk factor for VTE as well as venous thrombosis at unusual location, for example, cerebral sinus venous thrombosis, retinal vein obstruction, and Budd-Chiari syndrome. Growing evidence from observational studies indicates that abnormal fibrin clot properties can predict recurrent DVT and PE and they are involved in serious complications of VTE, for example, thromboembolic pulmonary hypertension and postthrombotic syndrome. The purpose of this article is to review our current understanding of the role of fibrin clot structure and function in venous thrombosis with emphasis on clinical issues ranging from prognosis to therapy.

Homocysteine Lowering by B Vitamins and the Secondary Prevention of Deep-Vein Thrombosis and Pulmonary Embolism. A First Randomised, Placebo-Controlled, Double-Blind Trial.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 489-489 ◽  
Author(s):  
Gerard M.J. Bos ◽  
Martin Heijer den ◽  
Huub Willems ◽  
Henk Blom ◽  
Wim Gerrits ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Relative Risk ◽  
Venous Thrombosis ◽  
Risk Reduction ◽  
B Vitamins ◽  
Homocysteine Concentration ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Hyperhomocysteinemia is a risk factor for venous thrombosis and arterial vascular disease. Supplementation with B-Vitamins (folic acid, vitamin B12 and vitamin B6) reduces homocysteine concentrations by 25–30% in healthy subjects and in patients with venous thrombosis. Until now, there are no results of clinical trials of the effect of homocysteine lowering by B-vitamins on the risk of venous thrombosis. In the VITRO (Vitamins and Thrombosis) study, we investigated the effect of daily supplementation of 5 mg folic acid, 50 mg of pyridoxin and 0.4 mg hydroxycobalamin as secondary prevention of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Patients with primary DVT or PE who were registered for out-patient treatment with an anticoagulation clinic, were asked to participate. Homocysteine was measured and information was retrieved about the diagnosis and circumstances in which patients developed their thrombosis. Patients between 20 to 80 years old with objectively confirmed proximal DVT or PE in the absence of other major risk factors for deep-vein thrombosis (surgery, pregnancy and child-bed, long-term immobility) and a homocysteine concentration in the top quartile entered the study. After informed consent they were randomised to high-dose multivitamin supplementation or placebo and were followed for 2.5 years. End-points were recurrent DVT or PE, as diagnosed by the physician of the patient. Parallel to this study a similar study was conducted in a random sample of patients in the lower three homocysteine quartiles. Subjects were divided according to their homocysteine level in a hyperhomocysteinemic (with a homocysteine concentration in the top quartile, n=360) and a normohomocysteinemic group (a random sample of patients with a homocysteine concentration in the lower three homocysteine quartiles, n=325). The number of recurrent events of thrombosis were 43 out of 348 in the vitamin group (54/1000yr) and 50 out of 353 in the placebo group( 64/1000yr). The relative risk associated with vitamin treatment in the hyperhomocysteinemic group was 1.14 (95%CI 0.65–1.98) and in the normohomocysteinemic group 0.58 (95%CI 0.31–1.07). The overall relative risk was 0.84 (95%CI 0.56–1.26). A baseline homocysteine above the 90th percentile was associated with an increased risk for recurrence of venous thrombosis (RR= 1.9 (95%CI 1.1 tot 3.3). This effect was independent of the treatment regimen. The results of our study does not provide evidence that homocysteine lowering by B-vitamin supplementation prevents recurrent venous thrombosis. The precision of our estimates does not allow to distinguish between ‘no effect’ or a 10 to 20% relative risk reduction. However such risk reduction would mean low absolute risk reduction and a number needed to treat of about 50. The fact that baseline homocysteine concentration is a risk factor for recurrence of thrombosis, independent of the treatment, does suggest that other factors - related to homocysteine but not folate - might be involved in the pathogenesis of recurrent thrombosis.

Low-dose subcutaneous heparin in prevention of deep-vein thrombosis

1972 ◽  
Vol 10 (23) ◽  
pp. 89-91
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Low Dose ◽  
Fatal Pulmonary Embolism ◽  
Vein Thrombosis ◽  
Subcutaneous Heparin ◽  
Prevention And Treatment ◽  
Deep Vein ◽  
Low Dosage

Earlier this year1 we discussed the prevention and treatment of venous thrombosis and concluded that heparin in low dosage seemed the most promising drug for preventing deep-vein thrombosis postoperatively, although the optimum regimen was not yet known. Sharnoff and his associates who began this work 10 years ago claim to have shown that this treatment largely prevents fatal pulmonary embolism.2

Prevention effect of orally active heparin derivative on deep vein thrombosis

2006 ◽  
Vol 96 (08) ◽  
pp. 149-153 ◽  
Author(s):  
Sang Kim ◽  
Dong Lee ◽  
Choong Kim ◽  
Hyun Moon ◽  
Youngro Byun
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Thrombus Formation ◽  
Sprague Dawley ◽  
Vein Thrombosis ◽  
Sprague Dawley Rats ◽  
Acid Conjugate ◽  
Deep Vein ◽  
Orally Active

SummaryThe use of heparin as the most potent anticoagulant for the prevention of deep vein thrombosis and pulmonary embolism is nevertheless limited, because it is available to patients only by parenteral administration. Toward overcoming this limitation in the use of heparin, we have previously developed an orally active heparin-deoxycholic acid conjugate (LMWH-DOCA) in 10% DMSO formulation. The present study evaluates the anti-thrombogenic effect of this orally active LMWH-DOCA using a venous thrombosis animal model with Sprague-Dawley rats. When 5 mg/kg of LMWH-DOCA was orally administered in rats, the maximum anti-FXa activity in plasma was 0. 35 ± 0. 02, and anti-FXa activity in plasma was maintained above 0. 1 IU/ml [the minimum effective anti-FXa activity for the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE)] for five hours. LMWH-DOCA (5 mg/kg, 430 IU/kg) that was orally administered reduced the thrombus formation by 56. 3 ± 19. 8%;on the other hand, subcutaneously administered enoxaparin (100 IU/kg) reduced the thrombus formation by 36. 4 ± 14. 5%. Also, LMWH-DOCA was effectively neutralized by protamine that was used as an antidote. Therefore, orally active LMWH-DOCA could be proposed as a new drug that is effective for the longterm prevention of DVT and PE.

High Incidence of Pelvic Deep Vein Thrombosis Detected by Magnetic Resonance Venograpy Post-Caesarean Section.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2600-2600
Author(s):  
Marc Rodger ◽  
Leonard Avruch ◽  
Andre Olivier ◽  
Mark Walker
Keyword(s):  
Deep Vein Thrombosis ◽  
Magnetic Resonance ◽  
Caesarean Section ◽  
Confidence Interval ◽  
Post Partum ◽  
Pelvic Vein ◽  
Vein Thrombosis ◽  
Compression Ultrasound ◽  
Vein Imaging ◽  
Deep Vein

Abstract Background Venous thromboembolism (VTE) is the leading cause of maternal mortality in the developed world. The post-partum period is the highest risk period for pregnancy associated VTE and delivery by Caesarean section further increases this risk. The true incidence of deep vein thrombosis (DVT) post- Caesarean section is unknown but felt to be low. The limited number of screening studies conducted to date have not included systematic pelvic vein imaging. Objectives To determine the incidence of DVT post-Caesarean section using Magnetic Resonance Venograpy (MRV) and bilateral compression ultrasounds. Methods Prospective cohort study of moderate to high risk women (one or more VTE risk factors) post-Caesarean section. On the day of post-partum discharge we conducted systematic bilateral proximal leg vein compression ultrasound imaging to detect proximal leg DVT and pelvic vein imaging with magnetic resonance venography (MRV). MRVs were independently and blindly interpreted by two radiologists with disagreements resolved by consensus. MRVs were interpreted as demonstrating definite, probable, possible or no thrombosis. Two rater Kappa scores were calculated from initial interpretations (prior to consensus review). Incidence of DVT and 95% confidence interval were calculated. Results Fifteen patients were recruited. At discharge, there were no proximal DVTs on bilateral leg compression ultrasounds. MRV results are shown in Table I. Conclusions The incidence of pelvic vein DVT post- Caesarean section is much higher than anticipated (46%). The clinical significance of this finding remains to be determined. However, diagnoses such as septic pelvic vein thrombophlebitis, which depend on demonstrating the presence pelvic vein thrombosis in the setting of post-partum fever may be falsely overdiagnosed. Pelvic vein thrombosis may be a common (and normal) finding post-Caesarean section. MRV may also prove to be a useful surrogate outcome measure in post-partum VTE prophylaxis studies. Table I: Pelvic Vein Imaging Results Post-C-Section MRV Consensus Result n/N (%) 95% CI Two Rater Kappa 95% CI= 95% Confidence Interval Definite Thrombosis 7/15 (46%) 21–73% 0.5 Definite or Probable Thrombosis 8/15 (53%) 27–79% 0.6 Definite, Probable or Possible Thrombosis 10/15 (66%) 38–88% 1.0 No Thrombosis 5/15 (33%) 12–62% 1.0

The Persistance of Residual Vein Thrombosis, after an Episode of Deep Vein Thrombosis, and the Risk of New Overt Cancer and Cardiovascular Disease.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 262-262 ◽  
Author(s):  
Sergio Siragusa ◽  
Alessandra Malato ◽  
Raffaela Anastasio ◽  
Ignazio Abbene ◽  
Carlo Arcara ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Cardiovascular Event ◽  
Independent Risk Factor ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Recurrent Vte ◽  
Deep Vein ◽  
Subsequent Cancer

Abstract Background. We have recently demonstrated that the presence of Residual Vein Thrombosis (RVT), UltraSonography (US)-detected at the 3rd month after an episode of Deep Vein Thrombosis (DVT) of the lower limbs, is an independent risk factor for developing recurrent Venous Thromboembolism (VTE). The management of DVT patients by detection of RVT may, therefore, represent a simple and reproducible method for establishing the individual risk of recurrence and for tailoring the optimal duration of Oral Anticoagulants (OA) (Siragusa S et al. Blood2003;102(11):OC183a). At the present, it is unknown whether RVT may also identify patients at increased risk for cancer and/or cardiovascular disease (CD). Objective of the study. In patients with DVT of the lower limbs, we conducted a prospective study for evaluating the correlation between RVT and the risk of new overt cancer and/or CD. Materials and methods. Consecutive patients, with an episode of idiopathic or provoked DVT, were evaluated after 3 months from the index DVT; presence/absence of RVT was detected and patients managed consequently (table). The incidence of VTE recurrence, overt cancer and new CD was evaluated over a period of 3 years after the index DVT. Survival curves (Kaplan-Mayer) and related Breslow test have been used for statistics. Results. Three-hundred fourty-five patients were included in the analysis. The results are listed in the table and figures. The incidence of recurrent VTE and new overt cancer was statistically lower in patients without RVT than in those with RVT; no significant differences were found in the incidence of new CD. These data are applicable in patients with idiopathic or provoked index DVT. In patients with RVT, the advantage of prolonging anticoagulation for 12 months was lost at the end of the treatment. Conclusions. This is the first study evaluating the relationship between US-detected RVT and the risk of developing cancer and CD; RVT presence, at 3rd month from the index DVT, is an independent risk factor for recurrent VTE and indicates patients at risk for new overt cancer. This risk remains over a period of 3 years, independently whether index DVT was idiopathic or provoked. In these patients, the advantage of indefinite anticoagulation should be assessed in properly designed study. Incidence of events over a period of 3 years accordingly to RVT findings Group Number of patients Presence of RVT at the 3rd months of OA from the index DVT Duration of OA from the index DVT Incidence of recurrent VTE Incidence of new cancer Incidence of new CD *Part of these patients were originally randomized to receive 3 or 12 months of OA Group *A1 142 yes 12 months 11 (7.7%) 8 (5.6%) 7 (4.9%) Group *A2 91 yes 3 months 16 (17.5%) 9 (9.9%) 7 (7.7%) Group B 112 no 3 months 1 (0.9%) 3 (2.6%) 4 (3.5%) Figure 1: Relationship between RVT and subsequent Cancer Figure 1:. Relationship between RVT and subsequent Cancer Figure 2: Relationship between RVT and subsequent Cardiovascular Event Figure 2:. Relationship between RVT and subsequent Cardiovascular Event

scholarly journals High Altitude Is an Independent Risk Factor for Developing a Pulmonary Embolism, but Not a Deep Vein Thrombosis Following a 1- to 2-Level Lumbar Fusion

2019 ◽  
Vol 9 (7) ◽  
pp. 729-734 ◽  
Author(s):  
Chester J. Donnally ◽  
Ajit M. Vakharia ◽  
Jonathan I. Sheu ◽  
Rushabh M. Vakharia ◽  
Dhanur Damodar ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
High Altitude ◽  
Independent Risk Factor ◽  
Lumbar Fusion ◽  
Vascular Complications ◽  
Prior History ◽  
Vein Thrombosis ◽  
Deep Vein

Study Design: Retrospective study. Objective: To identify if a 1- to 2-level posterior lumbar fusion at higher altitude is an independent risk factor for postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods: A national Medicare database was queried for all patients undergoing 1- to 2-level lumbar fusions from 2005 to 2014. Those with a prior history of DVT, PE, coagulopathy, or peripheral vascular complications were excluded to better isolate altitude as the dependent variable. The groups were matched 1:1 based on age, gender, and comorbidities to limit potential cofounders. Using ZIP codes of the hospitals where the procedure occurred, we separated our patients into high (>4000 feet) and low (<100 feet) altitudes to investigate postoperative rates of DVTs and PEs at 90 days. Results: Compared with lumbar fusions performed at low-altitude centers, patients undergoing the same procedure at high altitude had significantly higher PE rates ( P = .010) at 90 days postoperatively, and similar rates of 90-day postoperative DVTs ( P = .078). There were no significant differences in age or comorbidities between these cohorts due to our strict matching process ( P = 1.00). Conclusion: Spinal fusions performed at altitudes >4000 feet incurred higher PE rates in the first 90 days compared with patients receiving the same surgery at <100 feet but did not incur higher rates of postoperative DVTs.

Management of Acute Iliofemoral Deep Vein Thrombosis

2018 ◽  
Author(s):  
Albeir Y Mousa
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
External Compression ◽  
Vein Thrombosis ◽  
Surgical Thrombectomy ◽  
Deep Vein

Acute deep venous thrombosis (DVT) of iliofemoral segment is one of the most dreaded presentations of venous thromboembolism, as it can not only compromise the function of the extremity but may also result in pulmonary embolism and even death. There are many causes for acute iliofemoral DVT, including underdiagnosed May-Thurner syndrome, hypercoagulable syndrome, and external compression on iliocaval segment. The available treatment depends on the acuity of the symptoms. Acute iliofemoral DVT can be treated with medical anticoagulation, pharmacomechanical therapy, including thrombolysis or surgical thrombectomy. Chronic iliofemoral occlusion may be treated with recanalization of the occluded segments with angioplasty stenting. This review contains 4 Figures, 4 Tables and 63 references Key Words: acute, angioplasty, deep venous thrombosis, iliofemoral, inferior vena cava, pharmacomechanical therapy, occlusion, stent

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