scholarly journals Deep Venous Thrombosis (DVT) risk assessment on routine hemodialysis patient using Padua prediction score

2021 ◽  
Vol 1 (2) ◽  
pp. 32-34
Author(s):  
Benny Tjan ◽  
I Gusti Ngurah Agung Tresna Erawan ◽  
Yenny Kandarini
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Simple Random Sampling ◽  
Hemodialysis Patients ◽  
Prediction Score ◽  
History Of ◽  
Reduced Mobility ◽  
Pie Chart

Introduction: Hemodialysis requires invasive vascular access (VA) procedure which could emerge deep venous thrombosis (DVT) complication. Apart from VA, other risk factors, either modifiable or unmodifiable, could increase DVT risk. Those factors can be assessed by Padua Prediction Score (PPS). This study aims to assess which risk factors in PPS increase the risk of developing DVT in routine hemodialysis patients at BHCC main clinic. Methods: This research is a descriptive observational study with simple random sampling. The participants were 58 routine hemodialysis patients in BHCC. The inclusion criteria of this study were the ages above 17 years old, had history hemodialysis more than one, the patient willing to become of the sample subject. The patient that incompletely fulfills the questionnaire were already treated with anticoagulation were admitted for VTE, and had a history of discontinuing hemodialysis were excluded. The data were gathered using a questionnaire according to PPS. The data was analyzed by using SPP 25.0. The descriptive data was provided in a table and pie chart. Results: Based on the results of the PPS, 11 patients (18.96%) were among the high risk, and 47 patients (81.04%) were at low risk. The most potent risk factor in increasing the risk of DVT is reduced mobility with a risk priority number (RPN) of 30 (severity=3, occurrence=10). Recent (≤one month) trauma and surgery entail on second with an RPN of 24 (severity=2, occurrence=12). The third is occupied by heart and/or respiratory failure with a RPN of 14 (severity=1, occurrence=14). Previous VTE history with a RPN of 12 (severity=3, occurrence=4) placed fourth, followed by age≥ 70 (RPN=8, severity=1, occurrence=8) and obesity (BMI>= 30) with a RPN of 4 (severity=1, occurrence=4) at fifth and sixth respectively. Conclusion: "Reduced mobility" is the most prominent risk factor to increase DVT risk in routine hemodialysis patients, followed by other risk factors. Reduced mobility and obesity are modifiable risk factors that should be eliminated by educating routine hemodialysis patients.

The risk of venous thrombosis in individuals with a history of superficial vein thrombosis and acquired venous thrombotic risk factors

Blood ◽  
2013 ◽  
Vol 122 (26) ◽  
pp. 4264-4269 ◽  
Author(s):  
Rachel E. J. Roach ◽  
Willem M. Lijfering ◽  
Astrid van Hylckama Vlieg ◽  
Frans M. Helmerhorst ◽  
Frits R. Rosendaal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Superficial Vein ◽  
Thrombotic Risk ◽  
Vein Thrombosis ◽  
Thrombotic Risk Factor ◽  
Key Points ◽  
Superficial Vein Thrombosis ◽  
History Of

Key Points Superficial vein thrombosis combined with an acquired thrombotic risk factor increases the risk of venous thrombosis 10- to 100-fold. If confirmed, these findings have important implications for the future prevention of venous thrombosis.

Incidence and Risk Factors of the Post-thrombotic Syndrome

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 85-94 ◽  
Author(s):  
M A F De Wolf ◽  
C H A Wittens ◽  
S R Kahn
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Stratification ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inflammatory Markers ◽  
Patient Characteristics ◽  
Venous Occlusion ◽  
Post Thrombotic Syndrome

Annually 1–2 in every 1000 adults will develop a deep venous thrombosis of the lower extremity. A third to half of these patients will develop the post-thrombotic syndrome (PTS). However, predicting which patients will develop the PTS remains elusive. Ipsilateral thrombosis recurrence seems to be the most important risk factor. Moreover, residual venous occlusion and valvular reflux seem to predict PTS incidence to some degree. Laboratory parameters, including D-dimers and inflammatory markers, have shown promise in predicting development of the PTS in patients and are currently under investigation. Creating a model based on all combined risk factors and patient characteristics might aid in risk stratification in individual patients.

Deep Venous Thrombosis

Hematology ◽  
2004 ◽  
Vol 2004 (1) ◽  
pp. 439-456 ◽  
Author(s):  
José A. López ◽  
Clive Kearon ◽  
Agnes Y.Y. Lee
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Vessel Wall ◽  
Blood Stasis ◽  
Endothelial Activation ◽  
Medical Problem ◽  
Patients With Cancer ◽  
Increased Risk

Abstract Venous thromboembolism (VTE), manifested as either deep venous thrombosis (DVT) or pulmonary embolism (PE), is an extremely common medical problem, occurring either in isolation or as a complication of other diseases or procedures. Yet, despite its frequency, much remains to be learned regarding the pathogenic mechanisms that initiate VTE, about tailoring its treatment to the individual with her/his specific set of risk factors for recurrence, and about its medical management when associated with specific disease entities, such as cancer. These three topics are addressed in this chapter. In Section I, Drs. López and Conde discuss the mechanisms by which venous thrombi may be initiated on the vessel wall in the absence of anatomically overt vessel wall injury. The authors propose a model whereby tissue factor (TF)–bearing microvesicles that arise from cells of monocyte/macrophage lineage can fuse with activated endothelial cells in regions of vessel activation or inflammation and initiate blood coagulation. Key components of this model include docking of the microvesicles to the stimulated endothelium through P-selectin glycoprotein ligand–1 on their surfaces binding to either P-selectin or E-selectin on the endothelium, and the role of hypoxia during blood stasis in initiating local endothelial activation. Elevations in the levels of TF-bearing microvesicles associated with inflammatory conditions would help to explain the increased risk of thrombosis associated with infections and inflammatory states such as inflammatory bowel disease. In Section II, Dr. Clive Kearon discusses the risk factors for recurrent thrombosis and strategies for determining length of therapy and tailoring specific therapies through risk stratification. Those patients who experience VTE in association with a major reversible risk factor such as surgery are much less likely to experience a recurrence when anticoagulation is discontinued than are patients with a persistent risk factor, such as thrombophilia or cancer unresponsive to therapy. Those with a minor reversible risk factor, such as prolonged air travel, have an intermediate risk of recurrence after discontinuance of anticoagulant therapy. The author provides an algorithm for using risk assessment as a means of determining the length and type of therapy to be used to minimize the rate of recurrence while simultaneously diminishing the risk of bleeding associated with anticoagulation. In Section III, Dr. Agnes Lee updates the topic of VTE associated with malignancy. Patients with cancer make up approximately 20% of those presenting with first time VTE, and the presence of VTE forebodes a much poorer prognosis for patients with cancer, likely because of the morbidity associated with VTE itself and because VTE may herald a more aggressive cancer. Recent evidence indicates that low-molecular weight heparins (LMWHs) improve survival in patients with advanced cancer through mechanisms beyond their effect as anticoagulants. Because of their improved efficacy and safety and potential anti-neoplastic effect, the LMWHs have become the anticoagulants of choice for treating VTE associated with cancer.

Validation Of Medical Inpatient Venous Thrombosis Risk Assessment (MITH) Score

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2931-2931
Author(s):  
Damon E Houghton ◽  
Michael Desarno ◽  
Peter Callas ◽  
Allen B Repp ◽  
Mary Cushman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Sensitivity And Specificity ◽  
Validation Cohort ◽  
Medical Inpatients ◽  
History Of ◽  
Hospital Acquired ◽  
Present On Admission

Abstract Introduction Governmental agencies recommend risk assessment of venous thrombosis (VT) for medical inpatients at admission and provision of VT prophylaxis for moderate to high risk patients. While several risk factor models for predicting hospital-acquired VT have been proposed, none have been widely accepted and few have been prospectively validated. We sought to validate the recently published MITH VT risk assessment model in an independent cohort of medical inpatients (Zakai et al, Journal of Thrombosis and Haemostasis 2013). Methods Hospital-acquired VT and risk factors present at admission were collected from adult inpatients between June 2009 and April 2012 admitted to the medicine, medical intensive care, hematology/oncology, or cardiology services at Fletcher Allen Hospital (500 bed teaching hospital for the University of Vermont). Hospital-acquired VT was defined using VT discharge ICD-9 codes (flagged as not present on admission) and record of an imaging study that could diagnosis VT (such as duplex ultrasound, computed tomography angiography, or ventilation perfusions scan). Inpatients with VT ICD-9 codes flagged as present on admission were excluded. The sensitivity and specificity of the definition was confirmed by chart review of 30 cases of hospital-acquired VTE and 30 non-cases. Risk factors for hospital-acquired VT were captured using ICD-9 codes from the problem list, discharge codes, vital signs, and laboratory values at admission. The MITH score was calculated for each patient based on the points for each risk factor: history of heart failure = 5 pts, history of rheumatologic disease = 4 pts, history of fracture in past 3 months = 3 pts, history of cancer in past 12 months = 1 pt, tachycardia (HR>100 at admission) = 2pt, respiratory dysfunction (SpO2<90% at admission or intubated on hospital day 1) = 1 pt, white blood cell count >11 = 1 pt, platelet count >350 = 1 pt. The absolute rates of hospital-acquired VT for different cut points of the score were calculated and compared qualitatively to those previously published for the MITH score. Results There were 120 hospital-acquired VT events complicating 20,334 medical admissions (5.9 cases per 1,000 hospital admissions). The sensitivity and specificity of our definition of hospital-acquired VT was 100% and 91%, respectively. The table presents the prevalence of the MITH score at various cut-offs in cases and non-cases as well as the incidence of VT. In the derivation of the MITH score, the rate of VT per 1000 admissions for a score <1, <2, or <3 was 1.0, 1.5, and 2.1 compared with 0.7, 1.8, and 2.2 VT per 1000 admissions for the validation cohort. The incidence of VTE in the derivation of the MITH score for a score ≥1, ≥2, and ≥3 was 6.0, 8.9, and 12.4 per 1000 admissions compared with 7.9, 9.0, and 10.3 per 1000 admissions in the validation cohort. Conclusions We have validated a previously published VT risk score for hospitalized medical patients in an independent population. Determination of a patient's risk of VT at admission using readily available clinical and laboratory data could allow physicians to make informed decisions about risks and benefits of DVT prophylaxis. Further work is required to determine at what level of risk pharmacologic VT prophylaxis is warranted in this patient population. Disclosures: No relevant conflicts of interest to declare.

Clinical risk factors to predict deep venous thrombosis post-endovenous laser ablation of saphenous veins

2013 ◽  
Vol 29 (3) ◽  
pp. 150-153 ◽  
Author(s):  
Y-W Chi ◽  
T C Woods
Keyword(s):  
Risk Factors ◽  
Laser Ablation ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Female Gender ◽  
Clinical Risk Factors ◽  
Endovenous Laser Ablation ◽  
Clinical Risk ◽  
Saphenous Veins ◽  
History Of

Objective: Endovenous laser ablation of saphenous veins is an alternative in treating symptomatic varicose veins. Deep venous thrombosis (DVT) has been reported in up to 7.7% of patients undergoing such procedure. We sought to establish clinical risk factors that predict DVT post-endovenous laser ablation. Method: Patients who underwent endovenous laser ablation were prospectively followed. Clinical data and post-interventional duplex ultrasound were analysed. A P value <0.05 was accepted as representing a significant difference. Results: From 2007 to 2008, 360 consecutive patients were followed. Nineteen DVTs were found on follow-up ultrasound. Eighteen cases involved either the saphenofemoral or saphenopopliteal junctions; only one case involved the deep venous system. Age >66 ( P = 0.007), female gender ( P = 0.048) and prior history of superficial thrombophlebitis (SVT) ( P = 0.002) were associated with increased risk of DVT postprocedure. Conclusion: Age >66, female gender and history of SVT were significant predictors of DVT post-endovenous laser ablation of saphenous veins.

Higher Baseline Hemoglobin and Splenectomy Are Risk Factors for Venous Thromboembolism in Adults with Sickle Cell Variant Genotypes

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3243-3243
Author(s):  
Rakhi P. Naik ◽  
Michael B. Streiff ◽  
Julie Nelson ◽  
Sophie Lanzkron
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Sickle Cell ◽  
Research Funding ◽  
Hemoglobin Level ◽  
History Of ◽  
Cell Variant ◽  
Baseline Hemoglobin

Abstract Abstract 3243 Background: Sickle cell disease (SCD) is a hypercoagulable state, leading to increased rates of thrombotic complications such as stroke and venous thromboembolism (VTE). We have previously demonstrated an increased risk of non-catheter-related VTE among patients with sickle cell variant syndromes compared to those with sickle cell anemia (SS/Sβ0) genotypes. Variations in baseline laboratory values, including hemoglobin and hemolytic rate, have been shown to modify the risk of developing complications such as acute chest syndrome and retinopathy in SCD patients. In addition, splenectomy has been identified as a risk factor for VTE in patients with other hemoglobinopathies such as β-thalassemia intermedia. Therefore, we sought to determine the hematologic and clinical risk factors associated with VTE among our cohort of patients with SC and Sβ+thalassemia genotypes. Methods: We conducted a retrospective cohort study of all patients with hemoglobin SC or Sβ+thalassemia genotypes cared for at the Sickle Cell Center for Adults at Johns Hopkins between August 2008 and July 2012. Baseline hematologic parameters were recorded for all patients and were defined as steady-state outpatient laboratory values that were taken at least 1 month after a hospitalization and at least 3 months after a transfusion. Clinical data such as SCD-specific comorbidities and history of surgical splenectomy were also collected for all patients. A history of VTE was confirmed by radiography in the majority of cases. In cases where radiology was not available, only patients with a verified history of anticoagulation were included. Patients with a history of catheter-related VTE only were excluded (n=2). Results: Ninety-five patients with sickle variant genotypes had complete data and were included for analysis. The median age at follow-up was 42 years (range 21–72 years), and 55.8% of patients were female. Twenty-six (27.4%) patients had a history of VTE, 28.6% (8/28) with Sβ+thalassemia genotype and 26.9% (18/67) with SC genotype. Patients with a history of VTE had higher baseline hemoglobin levels compared to those without history of clot (11.6 g/dL vs. 10.8 g/dL, p<0.001). Additional laboratory parameters, including baseline WBC, platelet levels, and reticulocyte counts, did not significantly correlate to a history of VTE. A history of splenectomy was noted in 26.9% (7/26) of patients with VTE, 4 of whom developed a pulmonary embolism (PE) only, 2 of whom had a history of both deep venous thrombosis (DVT) and PE, and 1 of whom experienced an abdominal vein thrombosis. Splenectomy was significantly correlated to VTE on bivariate analysis (p=0.001), whereas other prevalent comorbidities such as avascular necrosis and retinopathy did not appear to be associated with VTE. On multivariate analysis controlling for demographics and genotype, older age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01–1.10, p=0.015), hemoglobin level (OR 3.82, CI 1.83–7.98, p<0.001) and history of splenectomy (OR 4.93, CI 1.10–22.14, p=0.038) were found to be independent risk factors for VTE in our cohort. On subgroup analysis by VTE type, increased hemoglobin level persisted as a risk factor for both DVT (OR 5.69, CI 2.04–15.83, p=0.001) and PE (OR 3.55, CI 1.65–7.68, p=0.001), but splenectomy was statistically correlated to PE only (OR 4.79, CI 1.05–21.78, p=0.043). Conclusions: In patients with SC and Sβ+ thalassemia genotypes, VTE is common complication and is associated with higher baseline hemoglobin levels. In addition, splenectomy appears to be a risk factor for VTE, and specifically PE, in this population. These findings suggest that increased whole blood viscosity and surgical splenectomy may play a role in the development of venous thrombosis in SCD. Further studies will be needed to determine if functional asplenia is also associated with VTE in patients with sickle cell variant genotypes, and whether laboratory parameters can be used to predict VTE risk in SCD. Disclosures: Naik: NHLBI (K12): Research Funding. Streiff:sanofi-aventis: Consultancy, Honoraria; BristolMyersSquibb: Research Funding; Eisai: Consultancy; Janssen Healthcare: Consultancy; Daiichi-Sankyo: Consultancy. Lanzkron:Hemaquest: Membership on an entity's Board of Directors or advisory committees; NHLBI: Research Funding.

The 20210 A Allele of the Prothrombin Gene Is a Common Risk Factor among Swedish Outpatients with Verified Deep Venous Thrombosis

1997 ◽  
Vol 78 (03) ◽  
pp. 0990-0992 ◽  
Author(s):  
Andreas Hillarp ◽  
Bengt Zӧller ◽  
Peter J Svensson ◽  
Bjӧrn Dahlbäck
Keyword(s):  
Risk Factor ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Odds Ratio ◽  
Untranslated Region ◽  
Control Group ◽  
Common Risk Factor ◽  
Apc Resistance ◽  
Healthy Control ◽  
Prothrombin Gene

SummaryA dimorphism in the 3’-untranslated region of the prothrombin gene (G to A transition at position 20210) has recently been reported to be associated with increases in plasma prothrombin levels and in the risk of venous thrombosis (1). We have examined the prothrombin dimorphism among 99 unselected outpatients with phlebography verified deep venous thrombosis, and in 282 healthy controls. The prevalence of the 20210 A allele was 7.1% (7/99) in the patient group, and 1.8% (5/282) in the healthy control group (p = 0.0095). The relative risk of venous thrombosis was calculated to be 4.2 (95% Cl, 1.3 to 13.6), and was still significant when adjustment was made for age, sex and the factor V:R506Q mutation causing APC resistance [odds ratio 3.8 (95% Cl, 1.1 13.2)]. As previously reported, 28% of the patients were carriers of the factor V:R506Q mutation. Thus, 34% (one patient carried both traits) of unselected patients with deep venous thrombosis were carriers of an inherited prothrombotic disorder. To sum up, our results confirm the 20210 A allele of the prothrombin gene to be an important risk factor for venous thrombosis.

The prevalence and risk factors associated with preoperative deep venous thrombosis in lung cancer surgery

Surgery Today ◽  
2021 ◽  
Author(s):  
Toshiki Takemoto ◽  
Junichi Soh ◽  
Shuta Ohara ◽  
Toshio Fujino ◽  
Takamasa Koga ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lung Cancer Surgery ◽  
Cancer Surgery ◽  
Factors Associated

scholarly journals Evaluating the Use of a Negative D-Dimer and Modified Low Wells Score in Excluding above Knee Deep Venous Thrombosis in an Outpatient Population, Assessing Need for Diagnostic Ultrasound

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Maryam Rahiminejad ◽  
Anshul Rastogi ◽  
Shirish Prabhudesai ◽  
David Mcclinton ◽  
Peter MacCallum ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limb ◽  
Clinical Risk Factor ◽  
Diagnostic Pathway ◽  
Clinical Diagnostic ◽  
Retrospective Audit ◽  
Wells Score ◽  
D Dimer

Aims. Colour doppler ultrasonography (CDUS) is widely used in the diagnosis of deep venous thrombosis (DVT); however, the number of scans positive for above knee DVT is low. The present study evaluates the reliability of the D-dimer test combined with a clinical probability score (Wells score) in ruling out an above knee DVT and identifying patients who do not need a CDUS. Materials and Method. This study is a retrospective audit and reaudit of a total of 816 outpatients presenting with suspected lower limb DVT from March 2009 to March 2010 and from September 2011 to February 2012. Following the initial audit, a revised clinical diagnostic pathway was implemented. Results. In our initial audit, seven patients (4.9%) with a negative D-dimer and a low Wells score had a DVT. On review, all seven had a risk factor identified that was not included in the Wells score. No patient with negative D-dimer and low Wells score with no extra clinical risk factor had a DVT on CDUS (negative predictive value 100%). A reaudit confirmed adherence to our revised clinical diagnostic pathway. Conclusions. A negative D-dimer together with a low Wells score and no risk factors effectively excludes a lower limb DVT and an ultrasound is unnecessary in these patients.

scholarly journals Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhanchao Tan ◽  
Hongzhi Hu ◽  
Xiangtian Deng ◽  
Jian Zhu ◽  
Yanbin Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Medical Data ◽  
Limited Information ◽  
Related Factors ◽  
Patella Fractures ◽  
Independent Risk Factors ◽  
Associated Risk Factors

Abstract Background Limited information exists on the incidence of postoperative deep venous thromboembolism (DVT) in patients with isolated patella fractures. The objective of this study was to investigate the postoperative incidence and locations of deep venous thrombosis (DVT) of the lower extremity in patients who underwent isolated patella fractures and identify the associated risk factors. Methods Medical data of 716 hospitalized patients was collected. The patients had acute isolated patella fractures and were admitted at the 3rd Hospital of Hebei Medical University between January 1, 2016, and February 31, 2019. All patients met the inclusion criteria. Medical data was collected using the inpatient record system, which included the patient demographics, patient’s bad hobbies, comorbidities, past medical history, fracture and surgery-related factors, hematological biomarkers, total hospital stay, and preoperative stay. Doppler examination was conducted for the diagnosis of DVT. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 716 patients, DVT was confirmed in 29 cases, indicating an incidence of 4.1%. DVT involved bilateral limbs (injured and uninjured) in one patient (3.4%). DVT involved superficial femoral common vein in 1 case (3.4%), popliteal vein in 6 cases (20.7%), posterior tibial vein in 11 cases (37.9%), and peroneal vein in 11 cases (37.9%). The median of the interval between surgery and diagnosis of DVT was 4.0 days (range, 1.0-8.0 days). Six variables were identified to be independent risk factors for DVT which included age category (> 65 years old), OR, 4.44 (1.34-14.71); arrhythmia, OR, 4.41 (1.20-16.15); intra-operative blood loss, OR, 1.01 (1.00-1.02); preoperative stay (delay of each day), OR, 1.43 (1.15-1.78); surgical duration, OR, 1.04 (1.03-1.06); LDL-C (> 3.37 mmol/L), OR, 2.98 (1.14-7.76). Conclusion Incidence of postoperative DVT in patients with isolated patella fractures is substantial. More attentions should be paid on postoperative DVT prophylaxis in patients with isolated patella fractures. Identification of associated risk factors can help clinicians recognize the risk population, assess the risk of DVT, and develop personalized prophylaxis strategies.

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