scholarly journals Pharmaco-prophylaxis of deep vein thrombosis for in-patients at risk, in a tertiary care hospital

2017 ◽  
Vol 7 (1) ◽  
pp. 44
Author(s):  
Sheetal John ◽  
Atiya R. Faruqui ◽  
Soumya Umesh
Keyword(s):  
Risk Assessment ◽  
Deep Vein Thrombosis ◽  
High Risk ◽  
Tertiary Care ◽  
Assessment Model ◽  
Care Hospital ◽  
Medical Specialties ◽  
Vein Thrombosis ◽  
Hospitalised Patients ◽  
Deep Vein

Background: There is limited data from India on Deep Vein Thrombosis (DVT) Prophylaxis. This study was done in hospitalised patients at high risk for DVT, to determine the patterns and rates of pharmacoprophylaxis, drugs used and their clinical outcomes.Methods: This prospective study screened patients for risk of DVT using the Padua risk assessment model. Padua score ≥4 were included and data on disease demographics, prophylaxis and outcomes of DVT at 12 weeks were collected. Factors affecting prophylaxis were assessed using multivariate logistic regression.Results: Out of 453 screened, 200 eligible patients were recruited. 48.5% were females; mean age was 54.6±16.6; 50.5% received some thromboprophylaxis, of which 24%, 35.5% and 9% received pharmacoprophylaxis, mechanoprophylaxis and a combination of both respectively. Low Molecular Weight Heparin was the most commonly used drug (77.1%). Adverse drug reactions reported were 24, none related to anticoagulant use. At 12 weeks, 18 (9%) patients gave history suggestive of DVT. 5 deaths were reported, but the cause could not be ascertained. Patients who had cardiac/ respiratory failure [OR =5.2 (95%CI - 1.13, 24.6), p = 0.03], acute MI or stroke [OR = 9.0 (3.5, 23.09), p <0.001], those admitted to medical specialties [OR = 3.4 -1.4, 7.9), p = 0.004] and to private wards [OR = 7.4 (3.13, 17.5), p <0.001] had significantly higher chances of receiving prophylaxis.Conclusions: Underutilisation of effective prophylaxis, despite high prevalence of DVT risk. Emphasis on routine risk assessment of hospitalized patients and administration of appropriate prophylaxis to those at high risk is required.

scholarly journals Outcomes of catheter-directed treatment of lower extremity deep vein thrombosis of patients presenting to a tertiary care hospital

2016 ◽  
Vol 26 (1) ◽  
pp. 73 ◽  
Author(s):  
Gaurav Sundar ◽  
ShyamkumarN Keshava ◽  
Vinu Moses ◽  
GeorgeK Chiramel ◽  
Munawwar Ahmed ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Vein Thrombosis ◽  
Deep Vein

Risk Assessment Model to Predict Recurrence in Patients with Unprovoked Deep Vein Thrombosis or Pulmonary Embolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 452-452
Author(s):  
Sabine Eichinger ◽  
Georg Heinze ◽  
Paul Alexander Kyrle
Keyword(s):  
Risk Assessment ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Recurrence Risk ◽  
Assessment Model ◽  
Risk Scores ◽  
Risk Assessment Model ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Abstract Abstract 452 Background: Venous thrombosis is a chronic and potentially fatal disease (case fatality 5-9%). Predicting the likelihood of recurrence is important, as most recurrences can be prevented by antithrombotic therapy, albeit at the price of an increased bleeding risk during anticoagulation. Despite a substantial progress in identifying the determinants of the recurrence risk, predicting recurrence in an individual patient is often not feasible. Venous thromboembolism (VTE) is a multicausal disease and the combined effect of clinical and laboratory factors on the recurrence risk is unknown. It was the aim of our study to develop a simple risk model that improves prediction of the recurrence risk in patients with unprovoked VTE. Methods and Findings: In a prospective multicenter cohort study we followed 929 patients with a first VTE after completion of at least 3 months of anticoagulation. The median observation time was 43.3 months. Patients with VTE provoked by surgery, trauma, cancer, pregnancy or oral contraceptive intake were excluded as were those with a natural inhibitor deficiency or the lupus anticoagulant. The main outcome measure was symptomatic recurrent VTE, which occurred in 176 patients. The probability of recurrence (95% CI) after 2, 5 and 10 years was 13.8% (11.6% to16.5%), 24.6% (21.6% to 28.9%), and 31.8% (27.6% to 37.4%), respectively. To develop a simple and easy to apply risk assessment model, clinical and laboratory variables (age, sex, location of VTE, body mass index, factor V Leiden, prothrombin G20210A mutation, D-Dimer, in vitro thrombin generation) were preselected based on their established relevance for the recurrence risk, simple assessment, and reproducibility. All variables were analyzed in a Cox proportional hazards model, and those significantly associated with recurrence were used to compute risk scores. Only male sex [HR vs. female 1.90 (95% CI 1.31–2.75)], proximal deep vein thrombosis [HR vs. distal 2.08 (95% CI 1.16–3.74)], pulmonary embolism [HR vs. distal thrombosis 2.60 (95% CI 1.49– 4.53)] and elevated levels of D-Dimer [HR per doubling 1.27 (95% CI 1.08–1.51)] or peak thrombin [HR per 100 nM increase 1.38 (95% CI 1.17–1.63)] were related to a higher recurrence risk. We developed a nomogram (Fig. 1) based on sex, location of initial thrombosis, and D-Dimer that can be used to calculate risk scores and to estimate the cumulative probabilities of recurrence in an individual patient. The model has undergone extensive validation by a cross-validation process. The cohort was divided into test and validation samples thereby mimicking independent validation. This process was repeated 1000 times and the results were averaged to avoid dependence of the validation results on a particular partition of our cohort. Patients were assigned to different risk categories according to their risk score, which corresponded well with the recurrence rate as patients with lower scores had lower recurrence rates. Conclusion: By use of a simple scoring system the assessment of the recurrence risk in patients with a first unprovoked VTE can be improved in routine care. Patients with unprovoked VTE in whom the recurrence risk is low enough to consider a limited duration of anticoagulation, can be identified. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Study to determine Wells criteria as a reliable clinical tool in diagnosis of deep vein thrombosis: a one year cross-sectional single centric hospital based study

2021 ◽  
Vol 8 (12) ◽  
pp. 3634
Author(s):  
Manoj D. Togale ◽  
Pulkit Gupta
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Color Doppler ◽  
Tertiary Care ◽  
Modern Medicine ◽  
Care Hospital ◽  
Clinical Tool ◽  
Cross Sectional ◽  
Vein Thrombosis ◽  
Deep Vein

Background: Venous thromboembolism which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) is one of the major cardiovascular causes of death along with myocardial infarction and stroke. DVT is a common problem in non-ambulatory and hospitalized patients. It is a major cause of morbidity and mortality in these patients. Venous thromboembolism mimics other illnesses making its diagnosis difficult. In such circumstances clinical improvement often fails to occur despite standard medical treatment of the concomitant illness.Methods: A prospective cross-sectional study was conducted at tertiary care hospital in which 40 patients with complaint of limb swelling were included. Risk was calculated according to the wells criteria and confirmed with color Doppler of the affected limb.Results: Majority of people were more than 50 years with male preponderance and with history of smoking present. Subjects had leg swelling with edema and calf tenderness. Results were well established in favor of Wells criteria for making diagnosis of DVT. This criterion showed 100% sensitivity with a negative predictive value of 100% and an accuracy of 90%.Conclusions: This criterion can help the clinicians to treat the disease before it takes a violent course and help the patients live a healthy life. The present study was done in a small proportion of patients. It is highly recommended that thorough studies and researches be conducted so that modern medicine can be highly efficacious, with newer techniques and procedures which can be beneficial for the patients.

scholarly journals Appropriateness of Pharmacologic Prophylaxis against Deep Vein Thrombosis in Medical Wards of an Ethiopian Referral Hospital

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Mohammed Biset Ayalew ◽  
Boressa Adugna Horsa ◽  
Meseret Tilahun Zeleke
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Medical Ward ◽  
Referral Hospital ◽  
Assessment Model ◽  
Total Risk ◽  
Vein Thrombosis ◽  
Active Hemorrhage ◽  
Pharmacologic Thromboprophylaxis ◽  
Deep Vein

Background. Most of hospitalized patents are at risk of developing deep vein thrombosis (DVT). The use of pharmacological prophylaxis significantly reduces the incidence of thromboembolic events in high risk patients. The aim of this study was to assess appropriateness of DVT prophylaxis in hospitalized medical patients in an Ethiopian referral hospital. Methods. Cross-sectional study design was employed. Patients with a diagnosis of DVT, taking anticoagulant therapy, and those who refused to participate were excluded from the study. Two hundred and six patients were included in the study using simple random sampling method. Modified Padua Risk Assessment Model was used to determine the risk of thromboembolism. SPSS (version 21) was used for analysis. Result. The total risk score for the study subjects ranged from 0 to 11 with a mean score of 3.41 ± 2.55. Nearly half (47.6%) of study participants had high risk to develop thromboembolism. Thrombocytopenia (platelets < 50 billion/L) or coagulopathy, active hemorrhage, and end stage liver disease (INR > 1.5) were the frequently observed absolute contraindications that potentially prevent patients from receiving thromboprophylaxis. Thromboprophylaxis use in nearly one-third (31.6%) of patients admitted in the medical ward of UoGRH was irrational. Patients who had high risk for thromboembolism are more likely to be inappropriately managed for their risk of thromboembolism and patients with thrombocytopenia or coagulopathy were more likely to be managed appropriately. Conclusion. There is underutilization of pharmacologic thromboprophylaxis in medical ward patients. Physicians working there should be aware of risk factors for DVT and indications for pharmacologic thromboprophylaxis and should adhere to guideline recommendations.

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