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Iding AFJ, Limpens TMP, Ten Cate H, Ten Cate-Hoek AJ. Chronic inflammatory diseases increase the risk of post-thrombotic syndrome: A prospective cohort study. Eur J Intern Med 2024; 120:85-91. [PMID: 37852838 DOI: 10.1016/j.ejim.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Clinical management of patients with deep vein thrombosis (DVT) is centered around their risk of recurrent venous thromboembolism (VTE) and post-thrombotic syndrome (PTS). While chronic inflammatory disease (CID) has been established as a risk factor of (recurrent) VTE, research about its potential impact on PTS is lacking. OBJECTIVES We aimed to assess the risk of PTS in patients with CID, stratifying for the use of anti-inflammatory treatment. PATIENTS/METHODS Consecutive patients with proximal DVT and no active cancer between 2003 and 2018 received a two-year prospective follow-up. CID included inflammatory bowel disease, rheumatic diseases, and gout. Residual venous obstruction (RVO) was assessed by compressive ultrasound after 3-6 months. PTS was diagnosed using the Villalta score after 6-24 months. Hazard ratios (HR) and odds ratios (OR) were adjusted for patient characteristics. The medical ethics committee approved this study. RESULTS In total 82 of 801 patients had CID (10.2 %). PTS more often developed in patients with CID (35.4% vs. 18.9 %, p < 0.001) than in those without CID (HR 1.72 [1.15-2.58]). The prevalence of RVO was similar in patients with and without CID (36.8% vs. 41.4 %), and RVO was strongly associated with PTS in patients with CID (OR 3.21 [1.14-9.03]). Moreover, patients with untreated CID (44 %, n = 36) more often had RVO than those with treated CID (51.6% vs. 26.7 %, p = 0.027), and accordingly had a higher risk of PTS (HR 2.18 [1.04-4.58]). CONCLUSIONS Patients with CID had an increased risk of developing PTS, especially those without anti-inflammatory treatment, possibly due to an unfavorable impact on RVO-related venous pathology.
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Affiliation(s)
- Aaron F J Iding
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Thrombosis Expertise Center, Heart+Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Thibaut M P Limpens
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Thrombosis Expertise Center, Heart+Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arina J Ten Cate-Hoek
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Thrombosis Expertise Center, Heart+Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
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Wu C, Zhang M, Gu W, Wang C, Zheng X, Zhang J, Zhang X, Lv S, He X, Shen X, Wei W, Wang G, Lu Y, Chen Q, Shan R, Wang L, Wu F, Shen T, Shao X, Cai J, Tao F, Cai H, Lu Q. Daily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: a prospective multicenter study. Intensive Care Med 2023; 49:401-410. [PMID: 36892598 DOI: 10.1007/s00134-023-07006-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Central venous catheter (CVC)-related thrombosis (CRT) is a known complication in critically ill patients. However, its clinical significance remains unclear. The objective of the study was to evaluate the occurrence and evolution of CRT from CVC insertion to removal. METHODS A prospective multicenter study was conducted in 28 intensive care units (ICUs). Duplex ultrasound was performed daily from CVC insertion until at least 3 days after CVC removal or before patient discharge from the ICU to detect CRT and to follow its progression. CRT diameter and length were measured and diameter > 7 mm was considered extensive. RESULTS The study included 1262 patients. The incidence of CRT was 16.9% (95% confidence interval 14.8-18.9%). CRT was most commonly found in the internal jugular vein. The median time from CVC insertion to CRT onset was 4 (2-7) days, and 12% of CRTs occurred on the first day and 82% within 7 days of CVC insertion. CRT diameters > 5 mm and > 7 mm were found in 48% and 30% of thromboses. Over a 7-day follow-up, CRT diameter remained stable when the CVC was in place, whereas it gradually decreased after CVC removal. The ICU length of stay was longer in patients with CRT than in those without CRT, and the mortality was not different. CONCLUSION CRT is a frequent complication. It can occur as soon as the CVC is placed and mostly during the first week following catheterization. Half of the thromboses are small but one-third are extensive. They are often non-progressive and may be resolved after CVC removal.
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Affiliation(s)
- Chunshuang Wu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
- Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
- Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Wenjie Gu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
- Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Caimu Wang
- The First Hospital of Ninghai, Ningbo, China
| | | | | | | | - Shijin Lv
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xuwei He
- Lishui People's Hospital, Lishui, China
| | - Xiaoyuan Shen
- The First People's Hospital of Xiaoshan District, Hangzhou, China
| | | | | | - Yingru Lu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Renfei Shan
- Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Lingcong Wang
- The First Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Feng Wu
- Zhejiang Quhua Hospital, Quzhou, China
| | - Ting Shen
- Yuyao People's Hospital of Zhejiang Province, Ningbo, China
| | - Xuebo Shao
- The First People's Hospital of Fuyang, Hangzhou, Hangzhou, China
| | - Jiming Cai
- The Second Hospital of Jiaxing, Jiaxing, China
| | - Fuzheng Tao
- Taizhou Integrated Chinese and Western Medicine Hospital, Taizhou, China
| | | | - Qin Lu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China.
- Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China.
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3
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Iding AFJ, Kremers BMM, Nagy M, Pallares Robles A, Ten Cate H, Spronk HMH, Ten Cate-Hoek AJ. Translational insights into mechanisms underlying residual venous obstruction and the role of factor XI, P-selectin and GPVI in recurrent venous thromboembolism. Thromb Res 2023; 221:58-64. [PMID: 36473362 DOI: 10.1016/j.thromres.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Residual venous obstruction (RVO) after deep vein thrombosis (DVT) is considered a risk factor of recurrent venous thromboembolism (VTE), arterial events and post-thrombotic syndrome (PTS). We hypothesized thrombo-inflammatory markers might be associated with RVO and clinical outcomes. MATERIALS AND METHODS In a DVT cohort with routine RVO-assessment and 5-year follow-up, patients were invited for blood withdrawal after stopping anticoagulants. Thrombin generation potential, coagulation enzyme:inhibitor complexes, soluble platelet markers and clinical markers were measured in platelet-poor plasma. Associations were represented as odds ratio (OR) or hazard ratio (HR) per standard deviation. RESULTS Patients with RVO (102/306, 33 %) had higher rates of PTS (24 vs. 12 %, p = 0.008), but similar rates of recurrence (16 vs. 15 %, p = 0.91) and arterial events (7 vs. 4 %, p = 0.26). RVO was associated with thrombin peak height (OR 1.40 [1.04-1.88]), endogenous thrombin potential (ETP, OR 1.35 [1.02-1.79]), and CRP (OR 1.74 [1.10-2.75]). Recurrent VTE was associated with ETP (HR 1.36 [1.03-1.81]), FXIa:C1-inhibitor (HR 1.34 [1.04-1.72]), thrombin:antithrombin (HR 1.36 [1.16-1.59]), soluble P-selectin (HR 2.30 [1.69-3.11]), soluble glycoprotein VI (sGPVI, HR 1.30 [1.01-1.69]), D-dimer (HR 1.56 [1.31-1.86]), and factor VIII (HR 1.44 [1.15-1.82]). Arterial events were associated with sGPVI (HR 1.80 [1.25-2.59]). PTS was not associated with any marker. CONCLUSIONS Our findings indicate RVO was associated with thrombo-inflammation, but this did not predict clinical outcomes in this setting. Importantly, we found recurrent VTE was associated with ongoing coagulation and platelet activation in patients well beyond the acute phase of DVT. Furthermore, sGPVI indicated an increased risk of arterial events, highlighting the role of platelets in arterial thrombosis following DVT.
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Affiliation(s)
- A F J Iding
- Thrombosis Expertise Center, Heart+Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
| | - B M M Kremers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - M Nagy
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - A Pallares Robles
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; Center of Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - H Ten Cate
- Thrombosis Expertise Center, Heart+Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; Center of Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - H M H Spronk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - A J Ten Cate-Hoek
- Thrombosis Expertise Center, Heart+Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
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4
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Elias A, Pernod G, Sanchez O. [How to make the diagnosis of venous thrombosis of the lower limbs?]. Rev Mal Respir 2019; 38 Suppl 1:e24-e31. [PMID: 31734046 DOI: 10.1016/j.rmr.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Elias
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine vasculaire, hôpital Sainte-Musse, 83100 Toulon, France
| | - G Pernod
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; CNRS/TIMC-IMAG UMR 5525/Thèmas, service universitaire de médecine vasculaire, CHU de Grenoble, université Grenoble-Alpes, 38700 La Tronche, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Université de Paris, service de pneumologie et soins intensifs, hôpital Européen Georges-Pompidou, AH-HP, 75015 Paris, France; Innovations Thérapeutiques en Hémostase, INSERM UMRS 1140, 75006 Paris, France.
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5
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Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. [Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV)]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:e1-e47. [PMID: 30770089 DOI: 10.1016/j.jdmv.2018.12.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38043 Grenoble, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, Hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, Hôpital Nord, CHU St-Étienne, 42, avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue de la Maison Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, 38043 Grenoble, France.
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6
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Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV). JOURNAL DE MEDECINE VASCULAIRE 2019; 44:28-70. [PMID: 30770082 DOI: 10.1016/j.jdmv.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens Picardie, avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38700 La Tronche, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, hôpital Nord, CHU St.-Étienne, 42, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St.-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 1328, avenue Maison-Blanche, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38043 Grenoble, France.
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Mumoli N, Mastroiacovo D, Giorgi-Pierfranceschi M, Pesavento R, Mochi M, Cei M, Pomero F, Mazzone A, Vitale J, Ageno W, Dentali F. Ultrasound elastography is useful to distinguish acute and chronic deep vein thrombosis. J Thromb Haemost 2018; 16:2482-2491. [PMID: 30225971 DOI: 10.1111/jth.14297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 12/18/2022]
Abstract
Essentials Ultrasound elastography uses tissue deformation to assess the relative quantification of its elasticity. Compression and duplex ultrasonography may be unable to correctly determine the thrombus age. Ultrasound elastography may be useful to distinguish between acute and chronic deep vein thrombosis. The exact determination of the thrombus age could have both therapeutic and prognostic implications. BACKGROUND: Background Ultrasound elastography (UE) imaging is a novel sonographic technique that is commonly employed for relative quantification of tissue elasticity. Its applicability to venous thromboembolic events has not yet been fully established; in particular, it is unclear whether this technique may be useful in determining the age of deep vein thrombosis (DVT). Thus, the aim of this study was to assess the role of UE in distinguishing acute from chronic DVT. Methods Consecutive patients with a first unprovoked acute and chronic (3 months old) DVT of the lower limbs were analyzed. Patients with recurrent DVT or with a suspected recurrence were excluded. The mean elasticity index (EI) values of acute and chronic popliteal and femoral vein thrombosis were compared. The accuracy of the EI in distinguishing acute from chronic DVT was also assessed by measuring the sensitivity, specificity, positive and negative predictive values, and likelihood ratios. Results One-hundred and forty-nine patients (mean age 63.9 years, standard deviation 13.6; 73 males) with acute and chronic DVT were included. The mean EI of acute femoral DVT was higher than that of chronic femoral DVT (5.09 versus 2.46), and the mean EI of acute popliteal DVT was higher than that of chronic popliteal DVT (4.96 versus 2.48). An EI value of > 4 resulted in a sensitivity of 98.9% (95% confidence interval [CI] 93.3-99.9), a specificity of 99.1% (95% CI 94.8-99.9), a positive predictive value of 91.1% (95% CI 77.9-97.1), a negative predictive value of 98.6% (95% CI 91.3-99.9), a positive likelihood ratio of 13.23 (95% CI 93-653) and a negative likelihood ratio of 0.001 (95% CI 0.008-0.05) for acute DVT. Conclusions UE appears to be a promising technique for distinguishing between acute and chronic DVT. Larger prospective studies are warranted to confirm our preliminary findings.
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Affiliation(s)
- N Mumoli
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - D Mastroiacovo
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | | | - R Pesavento
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - M Mochi
- General Electric Healthcare, Milano, Italy
| | - M Cei
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - F Pomero
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - A Mazzone
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - J Vitale
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
| | - W Ageno
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
| | - F Dentali
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
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8
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Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis. Blood 2018; 132:2298-2304. [PMID: 30237155 DOI: 10.1182/blood-2018-03-836783] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/02/2018] [Indexed: 11/20/2022] Open
Abstract
Thus far, the association between residual vein occlusion and immediate compression therapy and postthrombotic syndrome is undetermined. Therefore, we investigated whether compression therapy immediately after diagnosis of deep vein thrombosis affects the occurrence of residual vein obstruction (RVO), and whether the presence of RVO is associated with postthrombotic syndrome and recurrent venous thromboembolism. In a prespecified substudy within the IDEAL (individualized duration of elastic compression therapy against long-term duration of therapy for prevention of postthrombotic syndrome) deep vein thrombosis (DVT) study, 592 adult patients from 10 academic and nonacademic centers across The Netherlands, with objectively confirmed proximal DVT of the leg, received no compression or acute compression within 24 hours of diagnosis of DVT with either multilayer bandaging or compression hosiery (pressure, 35 mm Hg). Presence of RVO and recurrent venous thromboembolism was confirmed with compression ultrasonography and incidence of postthrombotic syndrome as a Villalta score of at least 5 at 6 and 24 months. The average time from diagnosis until assessment of RVO was 5.3 (standard deviation, 1.9) months. A significantly lower percentage of patients who did receive compression therapy immediately after DVT had RVO (46.3% vs 66.7%; odds ratio, 0.46; 95% confidence interval, 0.27-0.80; P = .005). Postthrombotic syndrome was less prevalent in patients without RVO (46.0% vs 54.0%; odds ratio, 0.65; 95% confidence interval, 0.46-0.92; P = .013). Recurrent venous thrombosis showed no significant association with RVO. Immediate compression should therefore be offered to all patients with acute DVT of the leg, irrespective of severity of complaints. This study was registered at ClinicalTrials.gov (NCT01429714) and the Dutch Trial registry in November 2010 (NTR2597).
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9
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Ivlev DA, Shirinli SN, Uzlova SG, Guria KG. Ultrasonic Monitoring of Blood Coagulation and Fibrinolysis under Intensive Blood Flow. Biophysics (Nagoya-shi) 2018. [DOI: 10.1134/s0006350918040085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Ageno W, Antonucci E, Cosmi B, Kovacs MJ, Gal GL, Ockelford P, Poli D, Prandoni P, Rodger M, Saccullo G, Siragusa S, Young L, Bonzini M, Caprioli M, Dentali F, Iorio A, Douketis JD, Donadini MP. Prognostic significance of residual venous obstruction in patients with treated unprovoked deep vein thrombosis. Thromb Haemost 2017; 111:172-9. [DOI: 10.1160/th13-04-0336] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 09/12/2013] [Indexed: 12/23/2022]
Abstract
SummaryResidual venous obstruction (RVO) could improve the stratification of the risk of recurrence after unprovoked deep vein thrombosis (DVT), but results from clinical studies and study-level meta-analyses are conflicting. It was the objective of this analysis to determine if RVO is a valid predictor of recurrent venous thromboembolism (VTE) in patients with a first unprovoked DVT who had received at least three months of anticoagulant therapy. Individual patient data were obtained from the datasets of original studies, after a systematic search of electronic databases (Medline, Embase, Cochrane Library), supplemented by manual reviewing of the reference lists and contacting content experts. A multivariate, shared-frailty Cox model was used to calculate hazard ratios (HRs) for recurrent VTE, including, as covariates: RVO; age; sex; anticoagulation duration before RVO assessment; and anticoagulation continuation after RVO assessment. A total of 2,527 patients from 10 prospective studies were included. RVO was found in 1,380 patients (55.1%) after a median of six months from a first unprovoked DVT. Recurrent VTE occurred in 399 patients (15.8%) during a median follow-up of 23.3 months. After multivariate Cox analysis, RVO was independently associated with recurrent VTE (HR = 1.32, 95% confidence interval [CI]: 1.06–1.65). The association was stronger if RVO was detected early, i.e. at three months after DVT (HR = 2.17; 95% CI: 1.11–4.25), but non-significant if detected later, i.e. >6 months (HR = 1.19; 95% CI: 0.87–1.61). In conclusion, after a first unprovoked DVT, RVO is a weak overall predictor of recurrent VTE. The association is stronger if RVO is detected at an earlier time (3 months) after thrombosis.
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Diagnosis of deep vein thrombosis recurrence: Ultrasound criteria. Thromb Res 2017; 161:78-83. [PMID: 29216479 DOI: 10.1016/j.thromres.2017.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/25/2017] [Accepted: 11/12/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Recurrent deep vein thrombosis (DVT) is often suspected in patients after anticoagulant drug withdrawal. The clinical signs can be confused with the onset of post-thrombotic syndrome. For these reasons, diagnosis of DVT recurrence must rely on an accurate method. MATERIALS AND METHODS In order to assess this challenging clinical issue, we performed an overview of the literature regarding ultrasound criteria for the diagnosis of recurrent DVT through a Medline search, which included articles published from January 1, 1980 to February 20, 2017. RESULTS Eighty-eight publications were found based on the defined keywords, of which nine articles with a relevant abstract were selected. By searching the reference lists of these nine articles, we obtained another 27 relevant articles. A new non-compressible vein or an increase in the diameter of a previously thrombosed vein segment by >4mm are sufficient to confirm the diagnosis of DVT recurrence. In contrast, an increase in diameter of <2mm enables recurrence to be ruled out. An increase between 2 and 4mm is deemed equivocal. Criteria based on echogenicity and Doppler venous blood flow are not reproducible. Other diagnostic imaging methods, mainly direct thrombus magnetic resonance imaging, are currently under evaluation. CONCLUSIONS Ultrasound remains the most useful test for the diagnosis of recurrent DVT. Further imaging tests need to be validated.
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Hansrani V, Dhorat Z, McCollum CN. Diagnosing of pelvic vein incompetence using minimally invasive ultrasound techniques. Vascular 2016; 25:253-259. [PMID: 27688293 DOI: 10.1177/1708538116670499] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Pelvic vein incompetence is a cause for pelvic pain and recurrent varicose veins in women. The gold standard diagnostic method is reflux venography involving radiation, nephrotoxic contrast and jugular puncture. Trans-vaginal ultrasound (TVU) is increasingly being used as a diagnostic tool for pelvic vein incompetence. Methods Fifty women with clinical suspicion of pelvic vein incompetence and aged between 18 and 55 years were recruited prospectively over two years at a large UK University Teaching Hospital. Trans-vaginal ultrasound was performed using a standardised protocol which included assessment of the ovarian and internal iliac veins bilaterally in the supine and semi-standing position with provocative manoeuvres. Diagnostic readability and inter-observer variability was determined. Results Mean (range) age of 43 (23-51). Visibility of all four pelvic veins was better in the supine position compared with semi-standing position (76% vs 64%). Pelvic vein incompetence was identified in 34 of 50 (68%) women in the supine position compared with 38 of 50 (76%) women in the semi-standing position. Pelvic vein incompetence was demonstrated in 35 of 50 (70%) women with Valsalva manoeuvre. Inter-observer variability was 0.84 (kappa, very good agreement, p = 0.001). Conclusion Trans-vaginal ultrasound is effective at demonstrating pelvic vein incompetence. All trans-vaginal ultrasound protocols should include assessment of pelvic veins in the supine and semi-standing position with Valsalva manoeuvre.
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Affiliation(s)
- Vivak Hansrani
- Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK
| | - Zainab Dhorat
- Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK
| | - Charles N McCollum
- Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK
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Sarolo L, Milan M, Turatti G, Bilora F, Prandoni P. Inter-observer variability of compression ultrasound for the assessment of residual vein thrombosis. Thromb Res 2016; 145:1-2. [DOI: 10.1016/j.thromres.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 12/29/2022]
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14
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Napolitano M, Saccullo G, Malato A, Sprini D, Ageno W, Imberti D, Mascheroni D, Bucherini E, Gallucci P, D'Alessio A, Prantera T, Spadaro P, Rotondo S, Di Micco P, Oriana V, Urbano O, Recchia F, Ghirarduzzi A, Lo Coco L, Mancuso S, Casuccio A, Rini GB, Siragusa S. Optimal Duration of Low Molecular Weight Heparin for the Treatment of Cancer-Related Deep Vein Thrombosis: The Cancer-DACUS Study. J Clin Oncol 2014; 32:3607-3612. [DOI: 10.1200/jco.2013.51.7433] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose We evaluated the role of residual vein thrombosis (RVT) to assess the optimal duration of anticoagulants in patients with cancer who have deep vein thrombosis (DVT) of the lower limbs. Patients and Methods Patients with active cancer and a first episode of DVT treated with low molecular weight heparin (LMWH) for 6 months were eligible. Patients were managed according to RVT findings: those with RVT were randomly assigned to continue LMWH for an additional 6 months (group A1) or to discontinue it (group A2), and patients without RVT stopped LMWH (group B). The primary end point was recurrent venous thromboembolism (VTE) during the 1 year after disconinuation of LMWH, and the secondary end point was major bleeding. Analyses are from the time of random assignment. Results Between October 2005 and April 2010, 347 patients were enrolled. RVT was detected in 242 patients (69.7%); recurrence occurred in 22 of the 119 patients in group A1compared with 27 of 123 patients in group A2. The adjusted hazard ratio (HR) for group A2 versus A1 was 1.37 (95% CI, 0.7 to 2.5; P = .311). Three of the 105 patients in group B developed recurrent VTE; adjusted HR for group A1 versus B was 6.0 (95% CI, 1.7 to 21.2; P = .005). Three major bleeding events occurred in group A1, and two events each occurred in groups A2 and B. The HR for major bleeding in group A1 versus group A2 was 3.78 (95% CI, 0.77 to 18.58; P = .102). Overall, 42 patients (12.1%) died during follow-up as a result of cancer progression. Conclusion In patients with cancer with a first DVT, treated for 6 months with LMWH, absence of RVT identifies a population at low risk for recurrent thrombotic events. Continuation of LMWH in patients with RVT up to 1 year did not reduce recurrent VTE.
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Affiliation(s)
- Mariasanta Napolitano
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Giorgia Saccullo
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Alessandra Malato
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Delia Sprini
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Walter Ageno
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Davide Imberti
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Doris Mascheroni
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Eugenio Bucherini
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Pina Gallucci
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Andrea D'Alessio
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Tullia Prantera
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Pietro Spadaro
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Stefano Rotondo
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Pierpaolo Di Micco
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Vincenzo Oriana
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Oreste Urbano
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Francesco Recchia
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Angelo Ghirarduzzi
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Lucio Lo Coco
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Salvatrice Mancuso
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Alessandra Casuccio
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Giovam Battista Rini
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
| | - Sergio Siragusa
- Mariasanta Napolitano, Giorgia Saccullo, Alessandra Malato, Delia Sprini, Lucio Lo Coco, Salvatrice Mancuso, Alessandra Casuccio, Giovam Battista Rini, and Sergio Siragusa, Università degli Studi di Palermo, Palermo; Walter Ageno, Università dell'Insubria, Varese; Davide Imberti, Ospedale di Piacenza, Piacenza; Doris Mascheroni, Istituto Clinico Villa Aprica, Como; Eugenio Bucherini, Ospedale di Faenza, Faenza Ravenna; Pina Gallucci, Centro Regionale Oncologico Basilicata, Rionero in Volture; Andrea
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Schellong SM. Diagnosis of recurrent deep vein thrombosis. Hamostaseologie 2013; 33:195-200. [PMID: 23817606 DOI: 10.5482/hamo-13-06-0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 06/18/2013] [Indexed: 12/11/2022] Open
Abstract
Deep vein thrombosis is a chronic disease with a continuing risk of recurrence. In a patient with recurrence long term prognosis and treatment are significantly altered both carrying their own risks not only in the acute phase but mainly in the long term perspective. Thus, accurate diagnosis of recurrence is of utmost importance for the fate of the patient. Diagnosis of a first DVT episode is well established and follows an algorithm including clinical prediction rules, D-Dimer testing and compression ultrasound. Due to the previous episode the efficiency of all three elements is impaired in a patient with suspected recurrence. This opens up areas of uncertainty which have to be filled by individual clinical judgement. Guidelines reflect this difficulty by providing mainly weak recommendations based on sparse data. The present review summarizes what is known about the performance of tools for DVT diagnosis, discusses recent guidelines, and finally gives personally weighed recommendations how to deal with this peculiar diagnostic situation. In conclusion, it will turn out that the well accepted diagnostic algorithm for a first DVT may be applied as well if the lower efficiency is regarded. Compression ultrasound largely benefits from a baseline assessment at the end of the previous episode. The order of tests may be discussed according to local and regional attitudes.
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Affiliation(s)
- S M Schellong
- Department of Internal Medicine II, Krankenhaus Dresden-Friedrichstadt, Teaching Hospital of Technical University of Dresden, Germany.
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