Incidence of deep vein thrombosis and justification of chemoprophylaxis in Indian patients: a prospective study

Clinical characteristics of venous thromboembolism onset from severe high altitude pulmonary edema in plateau regions

BACKGROUND

To investigate venous thromboembolism (VTE) in hospitalized patients with severe high altitude pulmonary edema (HAPE), we performed a single center retrospective study to evaluate its clinical characteristics, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center in plateau regions.

METHODS

We studied a total of 18 patients with severe HAPE from January 1, 2012 to December 31, 2021. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities and cardiac ultrasound, and computed tomographic pulmonary angiography (CTPA) variables were obtained, and comparisons were made between groups with and without VTE.

RESULTS

Of the 18 patients hospitalized with severe HAPE (age 43 (range, 34-54) years, 14 [77.8%] men), 7 patients developed VTE (38.9%), including 5 with deep vein thrombosis (DVT) and pulmonary embolism (PE), 2 of whom had DVT only. Eighteen patients are all firstly rapid ascent to high altitudes which the mean altitude was 3700 m (3656-4050 m). Compared with patients who did not have VTE, patients with VTE had a longer time in hospital (13 [11, 19] versus 9 [7, 12]; P = 0.027), respiratory failure (6 [85.7%] versus 2 [18.2%]; P = 0.013), the shortened APTT (21.50 [19.00, 27.50] versus 26.30 [24.80, 30.10]; P = 0.044) and the higher level of D-dimer (7.81 [4.62, 9.60] versus 2.90 [1.75, 3.37]; P = 0.003). The proportion of thromboprophylaxis is too low in our cohort which 2 of 18 (11.1%) patients were given VTE prophylaxis. There was no statistically significant difference between the VTE and non-VTE groups (0 [0.0%] versus 2 [18.2%]; P = 0.497).

CONCLUSIONS

The prevalence of VTE is high in hospitalized patients with severe high altitude pulmonary edema (HAPE). Prophylaxis for venous thromboembolism may be protective in severe HAPE patients after admission. Our data seem to suggest that VTE is probably an additional prognostic factors in patients with severe HAPE.

Doppler ultrasonographic evaluation of lower limbs deep-vein thrombosis in a teaching hospital, Northwestern Nigeria

Background

Deep-venous thrombosis (DVT) of lower limbs is one of the most common causes of death caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. B-mode and color Doppler imaging are needed for the early diagnosis of DVT to prevent complications and sequalae of DVT.

Objectives

The objectives of this study are to evaluate the role of Doppler ultrasound in diagnosing DVT of lower limbs and to study the spectrum of findings in patients with DVT in Zaria.

Methodology

A retrospective study was carried out on patients who had Venous Doppler Scan in the Department of Radiology ABUTH, Zaria, Nigeria, for suspected DVT over a period of 4 years from February 2014 to January 2018. Scans were done using DC-3 and DC-6 Mindray Ultrasound machines (2009 and 2013 Models, respectively, Shantou, China) coupled with high-frequency (7.5-12 MHz) linear and low-frequency curvilinear (2-5 MHz) transducers. Analysis of cases of DVT was performed in terms of age, sex, clinical features, predisposing conditions, anatomic distribution, stage, and pattern of thrombus involvement in the veins. Data were analyzed using the SPSS version 20.0 and value of P < 0.005 was considered as statistically significant.

Results

A total of 252 patients' results were reviewed which consisted of 122 males (48.4%) and 130 females (51.6%). The patients' ages ranged from 11 to 80 years, averaging 45.5 ± 9.56 years. The most common indication for Doppler request was leg swellings. The most common risk factor for DVT was malignancy (36%), cardiac disorders (18%), and traumas (14%). Sixty-six (61%) cases showed left-sided and 26 (24%) right-sided, whereas 16 (15%) cases showed bilateral lower limb involvement. Predominant thrombus was above-knee region with 54% in the superficial femoral vein. Chronic stage was seen in 46 (42%) cases, subacute in 44 (41%) cases, and acute in 18 (17%) cases.

Conclusion

Middle-aged females, left-sided leg, and above-knee segment were predominantly affected with DVT; hence, this buttresses the need for Doppler ultrasound in the diagnosis of DVT in all patients.

Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome

BACKGROUND

To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center.

METHODS

We studied a total of 143 patients with COVID-19 from January 29, 2020 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, and comparisons were made between groups with and without DVT.

RESULTS

Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 74 [51.7%] men), 66 patients developed lower extremity DVT (46.1%: 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased proportion of deaths (23 [34.8%] versus 9 [11.7%]; P=0.001) and a decreased proportion of patients discharged (32 [48.5%] versus 60 [77.9%]; P<0.001). Multivariant analysis showed an association only between CURB-65 (confusion status, urea, respiratory rate, and blood pressure) score 3 to 5 (odds ratio, 6.122; P=0.031), Padua prediction score ≥4 (odds ratio, 4.016; P=0.04), D-dimer >1.0 μg/mL (odds ratio, 5.818; P<0.014), and DVT in this cohort, respectively. The combination of a CURB-65 score 3 to 5, a Padua prediction score ≥4, and D-dimer >1.0 μg/mL has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 hours after admission, DVT was present in 18 (34.0%) patients in the subgroup receiving venous thromboembolism prophylaxis versus 35 (66.0%) patients in the nonprophylaxis group (P=0.010).

CONCLUSIONS

The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in hospitalized patients.

Incidence of clinically suspected venous thromboembolism in British Indian patients

Introduction Venous thromboembolism (VTE) remains a major public health issue around the world. Ethnicity is known to alter the incidence of VTE. To our knowledge, there are no reports in the literature investigating the incidence of VTE in British Indians. The aim of this study was to investigate the rates of symptomatic VTE in British Indian patients in the UK. Methods Patients referred to our institution between January 2011 and August 2013 with clinically suspected VTE were eligible for inclusion in the study. Those not of British Indian or Caucasian ethnicity were excluded. A retrospective review of these two cohorts was conducted. Results Overall, 15,529 cases were referred to our institution for suspected VTE. This included 1,498 individuals of British Indian ethnicity. Of these, 182 (12%) had confirmed VTE episodes. A further 13,159 of the patients with suspected VTE were coded as Caucasian, including 2,412 (16%) who had confirmed VTE events. VTE rates were a third lower in British Indians with clinically suspected VTE than in the equivalent Caucasian group. The British Indian cohort presented with VTE at a much earlier age than Caucasians (mean 57.0 vs 68.0 years). Conclusions This study suggests that British Indian patients have a lower incidence of VTE and are more likely to present at an earlier age than Caucasians. There was no significant difference in VTE type (deep vein thrombosis vs pulmonary embolism) among the ethnic groups. Clinicians should be aware of variations within ethnicities but should continue to adhere to existing VTE prevention guidance.