Warfarin-Induced Spontaneous Bilateral Breast and Extrathoracic Hematoma in an Elderly Woman

The Journal of Tehran University Heart Center ◽

10.18502/jthc.v15i2.4190 ◽

2020 ◽

Author(s):

Behnam Shakerian ◽

Negin Razavi

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Rare Disease ◽

Chest Wall ◽

Elderly Woman ◽

Warfarin Therapy ◽

Vein Thrombosis ◽

History Of ◽

Deep Vein

Warfarin- induced spontaneous breast hematoma is a very rare disease, with only a few cases having been reported in the literature so far. We describe an 80-year-old woman who had warfarin therapy due to deep vein thrombosis in a lower extremity. The patient was admitted with a history of swelling and red area on her bilateral breasts, chest wall, right arm, and right flank. She was treated conservatively with success. She was discharged after about 3 weeks without complications and was well at 6 months’ follow-up.

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Midterm Outcomes of Pharmacomechanical Thrombectomy in the Treatment of Lower Extremity Deep Vein Thrombosis With a Rotational Thrombectomy Device

Vascular and Endovascular Surgery ◽

10.1177/1538574417708726 ◽

2017 ◽

Vol 51 (5) ◽

pp. 301-306 ◽

Cited By ~ 2

Author(s):

Ahmet Yuksel ◽

Oktay Tuydes

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Postthrombotic Syndrome ◽

Technical Success Rate ◽

Vein Thrombosis ◽

Rotational Thrombectomy ◽

Thrombectomy Device ◽

Deep Vein

Background: The purpose of this study was to assess the safety and efficacy with midterm outcomes of pharmacomechanical thrombectomy (PMT) performed by using a relatively new thrombectomy device in the treatment of lower extremity deep vein thrombosis (DVT). Methods: Between February 2014 and February 2016, a total of 46 patients with lower extremity DVT were treated with PMT by using Cleaner rotational thrombectomy system. Preprocedural, intraprocedural, postprocedural, and follow-up records of patients were collected and retrospectively analyzed. Results: Mean age of patients was 50.5 (14.8) years, and 58.7% of them were female. Technical success rate of procedure was 91.3%. Mean procedure time was 81.8 (40.3) minutes. Early clinical improvement was observed in all patients with successful treatment. No serious adverse event related to procedure and mortality was observed. Mean follow-up time was 16.0 (7.9) months. Reocclusion was observed in 7 (17.5%) patients during the follow-up period. Venous patency rates of patients at 1-, 3-, 6-, and 12-month follow-up visits were 95%, 92.5%, 89.7%, and 79.5%, respectively. Mild, moderate, and severe postthrombotic syndrome were observed in 8 (20%) patients, 4 (10%) patients, and 1 (2.5%) patient, respectively. Postthrombotic syndrome–free survival rate was 67.5%. Conclusion: Cleaner rotational thrombectomy system appears to be safe and effective in the treatment of lower extremity DVT. Further larger randomized studies are needed to determine the long-term outcomes of this treatment modality.

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Safety of Excluding Suspected Deep Vein Thrombosis with a Single Whole-Leg Compression Ultrasound: Systematic Review and Meta-Analysis.

Blood ◽

10.1182/blood.v114.22.243.243 ◽

2009 ◽

Vol 114 (22) ◽

pp. 243-243 ◽

Cited By ~ 1

Author(s):

Stacy A Johnson ◽

Scott M Stevens ◽

Scott C Woller ◽

Erica Lake ◽

Marco Donadini ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Conflicts Of Interest ◽

Data Extraction ◽

Meta Analysis ◽

Diagnostic Efficiency ◽

Vein Thrombosis ◽

Compression Ultrasound ◽

Deep Vein

Abstract Abstract 243 Background: In patients with suspected lower extremity deep vein thrombosis (DVT), compression ultrasonography (CUS) is typically used as the initial test to confirm or exclude DVT. Patients with a negative CUS and either a moderate-to-high probability and/or a positive D-dimer usually require repeat CUS testing after 5–7 days to exclude proximal propagation of distal DVT, reducing diagnostic efficiency. Whole-leg compression ultrasound may safely exclude proximal and distal DVT in a single evaluation. Purpose: To assess the safety of withholding anticoagulation in patients presenting with suspected lower extremity DVT following a single negative whole-leg CUS. Methods: MEDLINE, EMBASE, CINAHL, LILACS, Cochrane, Health Technology Assessments databases were searched from January 1970 to April 2009 without language restrictions. This search was supplemented by reviewing Google, Google Scholar, clinicaltrials.gov, meeting abstracts, conference proceedings, reference lists, and by contacting content experts. Study Selection and Data Extraction: Randomized controlled trials and prospective cohort studies of patients with suspected DVT with a negative whole-leg CUS, not treated with anticoagulation, and followed at least 90 days for occurrence of venous thromboembolism (VTE). Studies required objective confirmation of VTE events during follow-up. Two authors independently reviewed articles and extracted data. Results: Six studies were included totaling 4,229 patients with negative whole-leg CUS exams and not receiving anticoagulation. VTE or suspected VTE-related death occurred within the follow-up period in 24 (0.6%) patients. Of these 24 events, 9 (37.5%) were distal DVT, 7 (29.2%) were proximal DVT, 6 (25.0%) were non-fatal pulmonary embolism, and 2 (8.3%) were deaths, possibly related to VTE. Combined VTE event rate at 3 months was 0.46% (95% CI 0.22, 0.70). Limitations: Pretest probability assessment was not available for all analyzed patients. Conclusions: Withholding anticoagulation in patients with suspected DVT based on a single whole-leg CUS is associated with a low risk of VTE (0.46%) during 3 months of follow-up. This strategy represents a safe and efficient alternative to serial CUS testing in patients with suspected DVT. Disclosures: No relevant conflicts of interest to declare.

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Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: The blind, prospective CALTHRO study

Thrombosis and Haemostasis ◽

10.1160/th10-06-0351 ◽

2010 ◽

Vol 104 (11) ◽

pp. 1063-1070 ◽

Cited By ~ 55

Author(s):

Benilde Cosmi ◽

Gianfranco Lessiani ◽

Giuseppina Rodorigo ◽

Giuliana Guazzaloca ◽

Carlotta Brusi ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

High Risk ◽

Vein Thrombosis ◽

Clinical Probability ◽

History Of ◽

The Difference ◽

Lost To Follow Up ◽

Deep Vein ◽

Compression Ultrasonography

SummaryThe natural history of calf deep-vein thrombosis (DVT) is still uncertain and it is debated whether it warrants to be diagnosed and treated. We aimed to investigate the complication rate of untreated isolated calf DVT (ICDVT). Symptomatic outpatients were prospectively managed with serial compression ultrasonography (SCUS). Those without proximal DVT and with likely pre-test clinical probability (PCP) or altered D-dimer received immediate subsequent complete examination of calf deep veins (CCUS) by a different operator. The result of CCUS was kept blind both to the managing doctor and the patient and disclosed after three months. Primary outcome was the rate of venous thromboembolism at three months. We examined 431 subjects (196 males; median age 68.0 years) in whom five outcomes were recorded (1.2%; 95% confidence intervals [CI]: 0.4–2.7). If CCUS results had been available, outcomes would have been recorded in 3/424 patients (0.7%; 95% CI: 0.2–2.1) with two events in subjects negative at both serial and complete CUS. ICDVT was diagnosed in 65 subjects (15.3%; 95% CI: 12–19); of whom 59 remained uneventful (one was lost to follow-up). A significant higher rate of outcomes was recorded in subjects with than without ICDVT (5/64; 7.8%; 95% CI: 3–17 vs. 3/351; 0.8%; 95% CI: 0–2; p=0.003). However, after excluding two events picked at serial CUS in subjects with ICDVT, the difference became barely significant (3/64; 4.7%; 95% CI: 1–13; p=0.049). Thrombotic evolution of untreated ICDVT in high-risk subjects may be relevant. Larger studies are needed to address this issue.

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Natural History of Isolated Below-Knee Vein Thrombosis in Patients with Spinal Cord Injury

Healthcare ◽

10.3390/healthcare9070861 ◽

2021 ◽

Vol 9 (7) ◽

pp. 861

Author(s):

Jang-Hyuk Cho ◽

Dong-Gyu Lee

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Deep Vein Thrombosis ◽

Natural History ◽

Vein Thrombosis ◽

Asian Patients ◽

Cord Injury ◽

History Of ◽

Deep Vein

In the general population, serial imaging is recommended over anticoagulant therapy for below-knee deep vein thrombosis (BKDVT). However, no clinical trial in Asian patients with spinal cord injury and BKDVT has been performed. Therefore, we evaluated the natural course of BKDVT in patients with acute spinal cord injury. We retrospectively analyzed inpatients with spinal cord injury with BKDVT between 2016 and 2020. All patients underwent inpatient rehabilitation treatment and duplex ultrasonographic examination of both the lower extremities at follow-up. After screening 172 patients with acute spinal cord injury for deep vein thrombosis using duplex ultrasound, 27 patients with below-the-knee deep vein thrombosis were included in this study. The mean lower-extremity motor score (median, interquartile range) was 66.0, 54.0–74.5. Sixteen patients received a non-vitamin K antagonist oral anticoagulant (NOAC) for anticoagulation. None of the patients had proximal propagation according to the follow-up duplex ultrasonography. BKDVT disappearance was not significantly different between the NOAC treatment and non-treatment groups. Asian patients with spinal cord injury have a low incidence of venous thromboembolism and favorable natural history of BKDVT. We recommend serial imaging over anticoagulant therapy for BKDVT in these patients.

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Natural history of deep vein thrombosis in children

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514536154 ◽

2014 ◽

Vol 30 (6) ◽

pp. 412-417 ◽

Cited By ~ 10

Author(s):

G Spentzouris ◽

A Gasparis ◽

RJ Scriven ◽

TK Lee ◽

N Labropoulos

Keyword(s):

Deep Vein Thrombosis ◽

Signs And Symptoms ◽

Chronic Venous Disease ◽

Venous Disease ◽

Vein Thrombosis ◽

History Of ◽

Recurrent Deep Vein Thrombosis ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

Objective To determine the natural history of deep vein thrombosis in children presented with a first episode in the lower extremity veins. Methods Children with objective diagnosis of acute deep vein thrombosis were followed up with ultrasound and clinical examination. Risk factors and clinical presentation were prospectively collected. The prevalence of recurrent deep vein thrombosis and the development of signs and symptoms of chronic venous disease were recorded. Results There were 27 children, 15 males and 12 females, with acute deep vein thrombosis, with a mean age of 4 years, range 0.1–16 years. The median follow-up was 23 months, range 8–62 months. The location of thrombosis involved the iliac and common femoral vein in 18 patients and the femoral and popliteal veins in 9. Only one vein was affected in 7 children, two veins in 14 and more than two veins in 6. Recurrent deep vein thrombosis occurred in two patients, while no patient had a clinically significant pulmonary embolism. Signs and symptoms of chronic venous disease were present at last follow-up in 11 patients. There were nine patients with vein collaterals, but no patient developed varicose veins. Reflux was found in 18 veins of 11 patients. Failure of recanalization was seen in 7 patients and partial recanalization in 11. Iliofemoral thrombosis ( p = 0.012) and failure to recanalize ( p = 0.036) increased significantly the risk for developing signs and symptoms. Conclusions Children with acute proximal deep vein thrombosis develop mild chronic venous disease signs and symptoms at mid-term follow-up and are closely related with iliofemoral thrombosis and failure to recanalization.

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