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Loffredo L, Vidili G, Sciacqua A, Cogliati C, Di Giulio R, Bernardini S, Ciacci P, Pietrangelo A, Orlando F, Paraninfi A, Boddi M, Di Minno G, Falsetti L, Lodigiani C, Santoliquido A, Ettorre E, Pignatelli P, Arezzo MF, Gutu E, Harenberg J, Violi F. Asymptomatic and symptomatic deep venous thrombosis in hospitalized acutely ill medical patients: risk factors and therapeutic implications. Thromb J 2022; 20:72. [PMID: 36451162 PMCID: PMC9709753 DOI: 10.1186/s12959-022-00433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acutely ill medical patients experience deep venous thrombosis (DVT) during the hospitalization, however the time course of DVT is still unclear. OBJECTIVES To evaluate risk factors in acutely ill hospitalized medical patients for proximal asymptomatic DVT (ADVT) and symptomatic DVT (SDVT) at admission and discharge. PATIENTS/METHODS In this prospective observational study, consecutive acutely ill medical patients (hospitalized mainly for acute medical disease as infections, neoplasm, anemia, heart failure) underwent compression ultrasonography (CUS) of proximal lower limb veins within 48 h from admission and at discharge to diagnose ADVT and SDVT. Covid-19 patients, anticoagulant therapy, surgical procedures, acute SDVT, and acute pulmonary embolism, were exclusion criteria. Biographical characteristics at hospitalization, D-Dimer (assessed by ELISA)) and DD-improve score. RESULTS Of 2,100 patients (1002 females, 998 males, age 71 ± 16 years) 58 (2.7%) had proximal ADVT at admission. Logistic regression analysis showed that age, and active cancer were independently associated with ADVT at admission. The median length of hospitalization was 10 days [interquartile range: 6-15]. During the hospital stay, 6 patients (0.3%) with a negative CUS at admission experienced DVT (2 SDVT and 4 ADVT). In the subgroup of patients (n = 1118), in whom D-dimer was measured at admission, D-Dimer and IMPROVE-DD score were associated with ADVT at admission (n = 37) and with all DVT (n = 42) at discharge. ROC curve defined an IMPROVE-DD score of 2.5 as the optimal cut-off for discriminating patients with and without thrombotic events. CONCLUSIONS We provide evidence of early development of ADVT in unselected acutely ill medical patients suggesting the need of investigating patients by CUS immediately after hospital admission (within 48 h). Advanced age, active cancer, known thrombophilia and increased IMPROVE-DD score may identify patients at risk. The benefit of anticoagulation needs to be investigated in patients with these specific risk factors and negative CUS at admission. TRIAL REGISTRATION NCT03157843.
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Affiliation(s)
- Lorenzo Loffredo
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gianpaolo Vidili
- grid.11450.310000 0001 2097 9138Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Angela Sciacqua
- grid.411489.10000 0001 2168 2547Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Catanzaro, Italy
| | - Chiara Cogliati
- grid.4708.b0000 0004 1757 2822 Department of Biomedical and Clinical Sciences, L.Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Rosella Di Giulio
- grid.416290.80000 0004 1759 7093Department of Internal Medicine, Internal Medicine Unit, Maggiore Hospital, Bologna, Italy
| | - Sciaila Bernardini
- grid.415207.50000 0004 1760 3756Department of Internal Medicine, AUSL Della Romagna, S. Maria Delle Croci Hospital, 48121 Ravenna, Italy
| | - Paolo Ciacci
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Antonello Pietrangelo
- grid.413363.00000 0004 1769 5275Department of Internal Medicine 2, University Hospital of Modena, Modena, Italy
| | - Federica Orlando
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Aurora Paraninfi
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Boddi
- grid.8404.80000 0004 1757 2304Experimental and Clinical Department, University of Florence, Florence, Italy
| | - Giovanni Di Minno
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lorenzo Falsetti
- grid.415845.9Internal and Sub-Intensive Medicine Department, A.O.U. “Ospedali Riuniti”, Ancona, Italy
| | - Corrado Lodigiani
- grid.417728.f0000 0004 1756 8807Cardiovascular Department, Thrombosis and Hemorrhagic Diseases Center, Humanitas Research Hospital, Rozzano, Milan Italy
| | - Angelo Santoliquido
- grid.8142.f0000 0001 0941 3192Catholic University of the Sacred Heart, Rome, Italy
| | - Evaristo Ettorre
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Pasquale Pignatelli
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Felice Arezzo
- grid.7841.aDepartment of Methods and Models for Economics, Territory and Finance, Sapienza University of Rome, Via del Castro Laurenziano, 9, 00161 Rome, Italy
| | - Evghenii Gutu
- grid.28224.3e0000 0004 0401 27383Rd Department of General Surgery, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Chisinau, Republic of Moldova
| | - Job Harenberg
- grid.7700.00000 0001 2190 4373Ruprecht-Kalrs University Heidelberg, Heidelberg, Germany
| | - Francesco Violi
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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