Risk Factors and Incidence of Deep Venous Thrombosis in Non-severe Coronavirus Disease-19 Patients

BACKGROUND: The coronavirus disease (COVID-19) is characterized by a high prevalence of deep vein thrombosis (DVT), particularly in its severe form, but the incidence of DVT and risk factors for DVT in non-severe patients are still unknown. METHODS: The study enrolled 118 patients with non-severe COVID-19 infection which did not required hospital admittance. A duplex ultrasound and laboratory test were performed in all the patients after the first negative polymerase chain reaction SARS-CoV-2 test. RESULTS: DVT was identified in 50 (42.4%) patients with a median age of 48 years (interquartile range 30–85 years). Symptomatic DVT was present in 40 (80%) patients and was commonly seen in the Class I calf vein thrombosis (38 patients, 76%) (χ2 = 51.71, p < 0.001). The most significant risk factors for DVT were as follows: Increased C-reactive protein (p = 0.000), fibrinogen (p = 0.000), low lymphocyte count (p = 0.002), obesity (p = 0.017), and neutrophil count (p = 0.042). The multivariable logistic regression analysis revealed that a D-dimer cutoff point of 1253.5 μg/L showed a sensitivity of 92% and a specificity of 71%. CONCLUSION: Patients with increased inflammatory markers and obese patients after a non-severe COVID-19 infection should have an ultrasound examination to ensure early diagnosis of DVT and to prevent the occurrence of any complications.

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Correlation of clinical features with the risk of lower limb deep vein thrombosis assessed by duplex ultrasound

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492013000200005 ◽

2013 ◽

Vol 12 (2) ◽

pp. 118-122

Author(s):

Liz Andrea Villela Baroncini ◽

Graciliano Jose Franca ◽

Aguinaldo de Oliveira ◽

Enrique AntonioVidal ◽

Carlos Eduardo Del Valle ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Clinical Symptoms ◽

Clinical Signs ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Vein Thrombosis ◽

Below The Knee ◽

Clinical Conditions ◽

Deep Vein

BACKGROUND: Symptoms and clinical signs suggestive of deep vein thrombosis (DVT) are common but may have numerous possible causes. OBJECTIVES: 1) To identify the most frequent clinical symptoms and correlate them with duplex ultrasound scan (DS) findings; 2) to identify high-risk clinical conditions for DVT; and 3) to evaluate time since the onset of symptoms and DS examination. METHODS: A total of 528 patients with a clinical suspicion of DVT were evaluated by DS performed by experienced vascular ultrasonographists. RESULTS: DVT was present in 192 (36.4%) of the patients. The external iliac vein was involved in 53 patients (10.04%), the femoral veins in 110 (20.83%), the popliteal vein in 124 (23.48%), and veins below the knee were involved in 157 (29.73%) of the cases. Limb swelling was present in 359 cases (68%), and 303 (57.4%) complained of pain. Sixty nine patients received a DS due to suspected or proven pulmonary embolism (PE); 79 patients were in postoperative period. In the multivariate analysis, independent risk factors for DVT included age>65 years (OR=1.49; 95% confidence interval [95%CI] 1.01-2.18; p=0.042), edema (OR=2.83; 95%CI 1.72-4.65; p<0.001), pain (OR=1.99; 95%CI 1.3-3.05; p=0.002), cancer (OR=2.32; 95%CI 1.45-3.72; p<0.001), and PE (OR=2.62; 95%CI 1.29-5.32; p=0.008).Time since the onset of symptoms did not differ between the groups. CONCLUSIONS: In the present study, 36.4% of the patients referred to DS had DVT. Age > 65 years, presence of limb swelling, pain, cancer, and suspected or proven PE should be considered as major risk factors for DVT.

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Risk factors for cerebral venous thrombosis and deep venous thrombosis in patients aged between 15 and 50 years

Thrombosis and Haemostasis ◽

10.1160/th09-06-0346 ◽

2009 ◽

Vol 102 (10) ◽

pp. 620-622 ◽

Cited By ~ 8

Author(s):

Maarten Uyttenboogaart ◽

Patrick C. A. J. Vroomen ◽

Jacques De Keyser ◽

Gert-Jan Luijckx ◽

Karen Koopman ◽

...

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Contraceptive Use ◽

Multivariable Logistic Regression Analysis ◽

Age Group ◽

Vein Thrombosis ◽

Oral Contraceptive Use ◽

Age Dependent ◽

Deep Vein

SummaryCerebral venous thrombosis (CVT) and deep vein thrombosis or pulmonary embolism (DVT/PE) are associated with many risk factors. It is unclear why CVT occurs less often than DVT/PE. Age dependent risk factors may play a role. The aim of our study was to compare risk factors in a uniform age group of CVT and DVT/PE patients aged between 15 and 50 years. Thrombophilic markers and clinical risk factors of 79 CVT patients and 173 DVT/PE patients aged 15–50 years were compared. Multivariable logistic regression analysis was performed to investigate if risk factors were independently associated with CVT or DVT/ PE. Cerebral venous thrombosis patients were younger (median age 30 years vs. 42 years; p<0.001) and more often female (82% vs. 52%; p<0.001). There were no differences in thrombophilic markers. Cerebral venous thrombosis was less often associated with trauma, immobilisation or surgery than DVT/PE (6% vs. 21%; adjusted OR 0.29; 95%CI 0.10–0.82). In women, CVT was more frequently associated with oral contraceptive use, pregnancy or puerperium (82% vs. 53%; adjusted OR 2.34; 95%CI 1.03–5.32).This study demonstrated no differences in thrombophilic markers between CVT patients and DVT/PE patients aged between 15 and 50 years, while the frequency of some transient risk factors was different. Cerebral venous thrombosis was relatively more common in women and hormonal factors may predispose to CVT compared to DVT/PE, while trauma, immobilisation and surgery may be less important in the pathophysiology of CVT.

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Analysis of Perioperative Risk Factors for Deep Vein Thrombosis in Patients With Femoral and Pelvic Fractures

10.21203/rs.3.rs-74152/v1 ◽

2020 ◽

Author(s):

Linqin Wu ◽

Bo Cheng

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Blood Transfusion ◽

Perioperative Period ◽

Pelvic Fractures ◽

C Reactive Protein ◽

Vein Thrombosis ◽

Reactive Protein ◽

Independent Risk Factors ◽

Deep Vein

Abstract Objective: Clinical characteristics, anticoagulant protocols and risk factors of deep Vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors.Methods: This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included. The Clinical data including general conditions,trauma, surgery,anticoagulant protocols and laboratory indexes were collected.According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group.Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT.Results: The incidence of DVT was 40.25%, PE was 1.93%, and preoperative DVT was 26.71%,which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%).The average time of DVT formation was 6.55±0.47 days after trauma and 6.67±0.48 days after surgery. Chronic obstructive pulmonary disease(COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT.The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7d, operative time > 2h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture.Conclusions: At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.

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Predisposing Factors for Deep Venous Thrombosis in Children and Adolescents with Nephrotic Syndrome

ISRN Vascular Medicine ◽

10.5402/2011/827483 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Gabriela de Toledo Passos Candelaria ◽

Vera Maria Santoro Belangero

Keyword(s):

Risk Factors ◽

Nephrotic Syndrome ◽

Deep Vein Thrombosis ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Children And Adolescents ◽

Odds Ratio ◽

Significant Risk ◽

Vein Thrombosis ◽

Deep Vein

Nephrotic syndrome (NS) is a state of hypercoagulability. In this paper, we sought to determine risk factors for the occurrence of deep vein thrombosis (DVT) in children with NS. The “with DVT” group included patients with decompensated NS and diagnosed with DVT. The “without DVT” group included the same patients, six to eighteen months prior to the episode of DVT, with decompensated NS but without DVT. Different prediction variables were analyzed. The odds ratio for the occurrence of DVT in patients with triglyceride levels ≥300 mg/dL was 3.14 (95% CI 1.14 to 8.64). For hematocrit levels ≥43% and for the presence of infection or a severe systemic event, the odds ratio was 4.37 (95% CI 1.23 to 15.53). The presence of significant risk factors for the occurrence of DVT in children with NS may serve as a warning for the occurrence of venous thrombosis.

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Differences in limb, age and sex of Chinese deep vein thrombosis patients

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514524192 ◽

2014 ◽

Vol 30 (4) ◽

pp. 242-248 ◽

Cited By ~ 9

Author(s):

Feng Chen ◽

Ji Xin Xiong ◽

Wei Min Zhou

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Age Groups ◽

Significant Risk ◽

Factors Affecting ◽

Vein Thrombosis ◽

Left Limb ◽

Deep Vein ◽

Age And Sex ◽

Compression Ultrasonography

Objective Recently, the differences in age or sex of deep vein thrombosis (DVT) patients have been widely debated. However, close analyses of the differences in limb, age and sex of Chinese DVT patients have been scarcely reported. The purpose of this research is to study the differences in limb, age and sex of DVT patients. Methods A total of 783 consecutive DVT patients were retrospectively reviewed. Patients with an acute presentation of DVT were diagnosed by means of compression ultrasonography or venography. Clinical characteristics and provoked risk factors were analyzed. Results There were three frequency peaks including two smaller peaks at age 20–24 and 70–74 years, and the largest peak at age 45–59 years. The most significant risk factors affecting different age groups were as follows: pregnancy/puerperium for age ≤39; fracture and hysterectomy for age 40–64; fracture and malignancy for age ≥65. DVT frequency rate provoked by malignancy was higher in right DVT than left DVT (15.8% vs. 4.6%; p < 0.001). Left DVT was more common than right DVT (582 vs. 158). Left DVT tended to occur in females (male:female, 40.5%:59.5%), and right DVT in males (male:female, 74.7%:25.3%). DVT provoked by pregnancy/puerperium (56/63, 88.9%) or hysterectomy (27/30, 90.0%) was mostly located in left limb. Conclusion It is necessary to pay more attention to thromboprophylaxis for patients with the risk factors of pregnancy/puerperium, hysterectomy, fracture and malignancy, especially those over the age of 65. And further research into the cause of limb, age and sex differences in DVT occurrence is needed.

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Prevalence of asymptomatic lower limb venous thrombosis in infertile women with thrombophilic disorders

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514539317 ◽

2014 ◽

Vol 30 (7) ◽

pp. 449-454

Author(s):

Luca Costanzo ◽

Luigi Di Pino ◽

Mario Ragusa ◽

Sergio Buccheri ◽

Andrea Sole ◽

...

Keyword(s):

Venous Thrombosis ◽

Prognostic Value ◽

Duplex Ultrasound ◽

Lower Limbs ◽

Control Group ◽

Infertile Women ◽

Vein Thrombosis ◽

Venous Circulation ◽

High Prevalence ◽

Deep Vein

Objective We sought to assess the prevalence of asymptomatic venous thrombosis in infertile women with thrombophilic disorders (TDs). Methods and results A total of 73 infertile women with TDs underwent duplex ultrasound scan to evaluate superficial and deep venous circulation of lower limbs. A control group of 35 infertile women without TDs was included. A single TD was found in 13 (17.8%) subjects, and 40 (54.8%) women presented a combined defect (more than three alterations). No residual mural thrombosis (RT) was noted in any deep veins. We found RT in 48 (65.8%) patients of TD group, while no RT was found in the control group ( p < 0.0001). None of the clinical and prothrombotic factors were predictors of RT (all p > 0.20), and frequency of TD did not correlate with multi-vessel RT ( p = 0.252). Conclusions No signs of deep vein thrombosis but high prevalence of superficial RT is present in infertile women with TDs. Further studies are needed to assess the prognostic value of our findings.

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Pulmonary Embolism in Neurocritical Care - Introduction of a Novel Grading System for Risk Stratification: The Frankfurt AMBOS Score

Neurosurgery ◽

10.1093/neuros/nyz310_833 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Daniel Dubinski

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Risk Stratification ◽

Neurocritical Care ◽

Smoking Status ◽

Significant Risk ◽

Blood Type ◽

Vein Thrombosis ◽

Deep Vein

Abstract INTRODUCTION Pulmonary embolism (PE) due to deep vein thrombosis is a complication with severe morbidity and mortality rates. Neurocritical care patients constitute an inhomogeneous cohort with often strict contraindications to conventional embolism treatment. The aim of the present study is to identify risk factors for PE for intensified risk stratification in this demanding cohort. METHODS Retrospective analysis which included age, gender, disease pattern, the presence of deep vein thrombosis, resuscitation, in-hospital mortality, present anticoagulation, coronary artery disease, diabetes mellitus, smoking status, hypertension, and ABO blood type. RESULTS Computed tomography confirmed 165 cases of PE among 387 patients with clinical suspicion of PE (42%). Younger age (P < .0001), female gender (P < .006), neuro-oncological disease (P < .002), non-O blood type (P < .002) and the absence of Marcumar therapy (P < .003) were identified as significant risk factors for PE. On the basis of the identified risk factors, the AMBOS score system is introduced. CONCLUSION Neurocritical care patients with high AMBOS score are at elevated risk for PE and should therefore be put under intensified monitoring for cardiovascular events in neurocritical care units.

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Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04196-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jixing Fan ◽

Fang Zhou ◽

Xiangyu Xu ◽

Zhishan Zhang ◽

Yun Tian ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Univariate Analysis ◽

High Energy ◽

Intertrochanteric Fractures ◽

Multivariate Logistic Regression ◽

Vein Thrombosis ◽

High Prevalence ◽

Deep Vein ◽

Time From Injury

Abstract Background Limited studies were available to investigate the prevalence of deep vein thrombosis (DVT) on admission in elderly patients with intertrochanteric fractures. The aim of present study was to evaluate risk factors and the prevalence of pre-admission DVT in elderly patients with intertrochanteric fractures. Methods This retrospective study included 788 elderly patients with intertrochanteric fracture who were eligible for this study from January 1, 2010, to December 31, 2019. Color doppler ultrasonography was performed for DVT detection at admission. All patients’ clinical data were collected. Univariate analysis and stepwise backward multivariate logistic regression were used to identify the risk factors contributing to the occurrence of DVT. Results The overall prevalence of pre-admission DVT in patients with intertrochanteric fractures was 20.81% (164 of 788 patients). The mean time from injury to admission was 2.1 days in the total population, 2.96 and 1.87 days in patients with and without DVT. Univariate analysis showed that significantly elevated risk of DVT were found in patients with longer time from injury to admission, high energy injury, lower Hb value, higher BMI, diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation, dementia, varicose veins, higher age-adjusted CCI, higher ASA class and A3 type intertrochanteric fractures (P < 0.05). The adjusted multivariate logistic regression analysis demonstrated that longer time from injury to admission, high energy trauma, COPD, lower Hb, diabetes and A3 type intertrochanteric fractures were independent risk factors of pre-admission DVT. Conclusions A high prevalence of pre-admission DVT was found in elderly Chinese patients with intertrochanteric fractures. Therefore, surgeons should be aware of the high prevalence of DVT for elderly patients with intertrochanteric fractures in order to prevent intraoperative and postoperative PE and other lethal complications.

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Prevalence of deep vein thrombosis (DVT) in non-surgical patients at hospital admission

Thrombosis and Haemostasis ◽

10.1160/th07-02-0107 ◽

2007 ◽

Vol 98 (10) ◽

pp. 765-770 ◽

Cited By ~ 12

Author(s):

Wibke Hoffmanns ◽

Phillip Hoffmanns ◽

Uli Rapp ◽

Michael Ames ◽

Alessandro Pira ◽

...

Keyword(s):

Internal Medicine ◽

Risk Factors ◽

The Elderly ◽

Acute Illness ◽

Surgical Patients ◽

Vein Thrombosis ◽

Reactive Protein ◽

Deep Vein ◽

D Dimer

SummaryVenous thromboembolism (VTE) is known as a common complication in surgical and non-surgical patients. We hypothesized that according to the underlying risk factors and the acute illness, the prevalence of VTE in non-surgical patients admitted to hospital is widely underestimated. For three months each patient admitted to the department of internal medicine with an acute illness, but without known deep venous thrombosis (DVT) was investigated by ultrasound compression sonography. Patients’ history, risk factors and extent of immobilisation were documented. In patients with newly detected DVT D-dimer and fibrinogen were measured as well as computer tomography scans performed. Follow-up investigations of the DVT population were performed at four weeks and three months. Six hundred seventeen patients (49.3% men) were included. In 16 patients (men=7) a previously unknown thrombosis (2.6%) was detected, mainly in patients with acute cardio-pulmonary disease (56%) and the elderly (mean age 75.6 years). Eight patients had femoro-popliteal (50.0%), four a femoral (25.0%), and four a popliteal vein thrombosis (25.0%). Five had pulmonary embolism (31.3%). In patients with DVT D-dimer was 875 ± 1,228 mg/l, fibrinogen 568 ± 215 mg/dl and C-reactive-protein 58.54 ± 73.65 mg/dl. One patient died from sepsis during hospitalisation, one died from sudden cardiac death at home. None of the other 14 surviving patients relapsed. The study shows a 2.6% risk for DVT in outpatients with acute illness admitted to the department of internal medicine. These data demonstrate the high risk of DVT is in non-surgical patients. Early prophylaxis has to be considered in internal medicine patients especially in the elderly.

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Incidence of deep venous thrombosis in COVID-19 hospitalized patients during the first peak of the Italian outbreak

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520975592 ◽

2020 ◽

pp. 026835552097559

Author(s):

Domenico Baccellieri ◽

Luca Bertoglio ◽

Luca Apruzzi ◽

Vincenzo Ardita ◽

Armando D’Angelo ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Duplex Ultrasound ◽

Tertiary Hospital ◽

Hospitalized Patients ◽

High Rate ◽

Vein Thrombosis ◽

Therapeutic Anticoagulation ◽

Medical Wards ◽

Deep Vein

Objectives A high rate of thrombotic events has been reported in COVID-19 population. The study aims to assess the incidence of deep vein thrombosis (DVT) in COVID-19 patients admitted to a single tertiary hospital. Methods From April 2nd to April 18th, 2020, hospitalized patients with SARS-CoV-2 infection were screened by lower limb duplex ultrasound (DUS). Patients were on (low molecular weight heparin) LMWH prophylaxis in medical wards, and on therapeutic anticoagulation in intensive care unit (ICU). DVT risk factors, reported by the Padua prediction score and blood tests, were retrieved from institutional electronic charts. The study primary endpoint was the incidence of DVT in the in-hospital COVID-19 population and its association with clinical and laboratory risk factors. The secondary endpoint was the association of DVT with mortality. Results Two hundred patients (median age 62 years, 72% male, 40 in ICU) received DUS screening. DVT was observed in 29 patients (14.5%), with proximal extension in 16 patients, and in association with symptoms in four patients. The DVT rate was similar in ICU (12.5%) and non-ICU patients (15%). Eighty-seven patients underwent a computed tomography angiography (CTA) that showed pulmonary embolism in 35 patients (40.2%) not associated with DVT in 25/35 cases (71.4%). DVT in the ten patients with pulmonary embolism were symptomatic in four and with a proximal localization in eight cases. A D-dimer level ≥5 mg/l at admission was predictive of DVT (OR 1.02; IC95% 1.03-1.16; p = .003). At the multivariate analysis in-hospital mortality was predicted by age (OR 1.06; 95% CI 0.02-1.15; p = .004) and by being an ICU patient (OR 1.23; 95% CI 0.30-2.25; p = .01). Conclusions Despite LMWH prophylaxis or full anticoagulant therapy, the incidence of DVT, mainly asymptomatic, in hospitalized COVID-19 patients was 14.5%. Further research should focus on the appropriate antithrombotic therapy for COVID-19 patients.

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