Materiały źródłowe

• #1 Clinical presentation and diagnosis of the nonpregnant adult with suspected deep vein thrombosis of the lower extremity – UpToDate

  https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-the-nonpregnant-adult-with-suspected-deep-vein-thrombosis-of-the-lower-extremity

  DVT is common. In general, the incidence of venous thromboembolism (VTE), comprising DVT and pulmonary embolism, is approximately 1 per 1000 annually in adults. […] Approximately two-thirds of VTE episodes manifest clinically as DVT. […] The prevalence of DVT varies with the population studied (eg, inpatient, outpatient, surgical, medical) and underlying risk factor(s) (eg, hormonal contraception, surgery, cancer). These details are discussed separately.

• #2 Deep Venous Thrombosis and Pulmonary Embolism: Current Therapy | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p295.html

  Pulmonary embolism and deep venous thrombosis are the two most important manifestations of venous thrombo-embolism (VTE), which is the third most common life-threatening cardiovascular disease in the United States. […] According to the Centers for Disease Control and Prevention, the annual incidence of VTE is one or two per 1,000 persons, and the overall mortality rate is between 60,000 and 100,000 annually. […] One-half of patients with DVT will have long-term complications, including postthrombotic syndrome and venous ulcers. One-third of patients with VTE will have a recurrence within 10 years. […] Approximately one-third of patients with VTE present with PE, and two-thirds present with DVT. […] The risk of VTE recurrence is greatest in the first year after the event and remains elevated indefinitely compared with the general population. Lifetime recurrence rates for DVT ranges from 21% to 30%, depending on the population.

• #3 Deep Vein Thrombosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507708/

  Deep vein thrombosis (DVT) is a common venous thromboembolic (VTE) disorder with an incidence of 1.6 per 1000 annually. […] It is thought the annual incidence of DVT is 80 cases per 100,000, with a prevalence of lower limb DVT of 1 case per 1000 population. Annually in the United States, more than 200,000 people develop venous thrombosis; of those, 50,000 cases are complicated by pulmonary embolism. […] Deep-vein thrombosis is rare in children, and the risk increases with age, most occurring in the over-40 age group. […] There is evidence from the United States that there is an increased incidence of DVT and an increased risk of complications in African Americans and white people compared to Hispanic and Asian populations.

• #4 Data and Statistics on Venous Thromboembolism | Venous Thromboembolism (Blood Clots) | CDC

  https://www.cdc.gov/blood-clots/data-research/facts-stats/index.html

  Up to 900,000 people in the United States are affected by venous thromboembolism (VTE, a blood clot), each year. […] The precise number of people affected by either a DVT or PE is unknown, although as many as 900,000 people could be affected each year in the United States. […] More than a third of VTE cases diagnosed each year are related to a recent hospitalization and most of these do not occur until after discharge. […] VTE is a leading cause of preventable hospital death in the United States. […] As many as 70% of cases of healthcare-associated VTEs are preventable through measures such as use of anticoagulant medications or compression stockings. […] An estimated one in five cases of VTE are related to cancer and its treatment. […] Women are five times more likely to experience a VTE during pregnancy, childbirth, or the 3-month period after delivery. […] One third (about 33%) of people with a VTE will have a recurrence within 10 years. […] Among people who have had a DVT, one third to one half will have long-term complications (post-thrombotic syndrome) such as swelling, pain, discoloration, and scaling in the affected limb.

• #5 National Public Health Crisis Deep-Vein Thrombosis Pulmonary Embolism – Hematology.org

  https://www.hematology.org/newsroom/press-releases/2010/national-public-health-crisis-deep-vein-thrombosis-pulmonary-embolism

  The American Society of Hematology has released three critical recommendations, developed from a national workshop held in partnership with the Centers for Disease Control and Prevention (CDC), to address deep-vein thrombosis (DVT) and pulmonary embolism (PE), a growing public health problem estimated to affect nearly 1 million Americans each year. […] There is a need to strengthen surveillance of DVT and PE in the United States to provide a geographically representative measure of the annual incidences of DVT and PE, with appropriate representation of all minority groups in proportions approximating the U.S. population. […] Currently, there isnt a national system for monitoring changes in the incidence of DVT and PE. […] It’s time to put in place an ongoing method of documenting the prevalence of these disorders and their consequences, identifying individuals affected by them, and determining which medical and public health strategies are working – or not working – to prevent and reduce DVT and PE.

• #6

  https://link.springer.com/article/10.1007/s11239-015-1311-6

  The estimated average annual incidence rate of overall VTE among persons of European ancestry ranges from 104 to 183 per 100,000 person-years; overall VTE incidence is similar to that of stroke. […] Overall VTE incidence may be higher in African-Americans and lower in Asians, and may differ among African-Americans by United States region. […] VTE is predominantly a disease of older age; VTE is rare prior to late adolescence. […] Incidence rates increase markedly with age for both men and women and for both DVT and PE. […] The overall age-adjusted incidence rate is higher for men than women. […] Data on trends in VTE incidence are limited; overall VTE incidence rates as well as incidence rates for PE DVT and DVT alone either remained relatively constant or increased for the period, 1981-2000, with a significant increase in the overall VTE incidence rate from 2001 to 2009, mostly due to an increasing incidence of PE DVT.

• #6

  https://link.springer.com/article/10.1007/s11239-015-1311-6

  VTE recurs frequently; about 30% of patients develop recurrence within the next 10 years. […] Independent predictors of recurrence include increasing patient age and body mass index, male sex, active cancer, and neurologic disease with leg paresis. […] Active cancer accounts for almost 20% of all incident VTE occurring in the community. […] Hospitalization and nursing home residence together account for almost 60% of incident VTE events occurring in the community.

• #7 Deep vein thrombosis – Wikipedia

  https://en.wikipedia.org/wiki/Deep_vein_thrombosis

  During pregnancy and after childbirth, acute VTE occurs in about 1.2 of 1000 deliveries. Despite it being relatively rare, it is a leading cause of maternal morbidity and mortality. After surgery with preventive treatment, VTE develops in about 10 of 1000 people after total or partial knee replacement, and in about 5 of 1000 after total or partial hip replacement. About 400,000 Americans develop an initial VTE each year, with 100,000 deaths or more attributable to PE. Asian, Asian-American, Native American, and Hispanic individuals have a lower VTE risk than Whites or Blacks. Populations in Asia have VTE rates at 15 to 20% of what is seen in Western countries, with an increase in incidence seen over time. In North American and European populations, around 48% of people have a thrombophilia, most commonly factor V leiden and prothrombin G20210A. For populations in China, Japan, and Thailand, deficiencies in protein S, protein C, and antithrombin predominate. Non-O blood type is present in around 50% of the general population and varies with ethnicity, and it is present in about 70% of those with VTE.

• #7 Deep vein thrombosis – Wikipedia

  https://en.wikipedia.org/wiki/Deep_vein_thrombosis

  About 1.5 out of 1000 adults a year have a first VTE in high-income countries. The condition becomes much more common with age. VTE rarely occurs in children, but when it does, it predominantly affects hospitalized children. Children in North America and the Netherlands have VTE rates that range from 0.07 to 0.49 out of 10,000 children annually. Meanwhile, almost 1% of those aged 85 and above experience VTE each year. About 60% of all VTEs occur in those 70 years of age or older. Incidence is about 18% higher in males than in females, though there are ages when VTE is more prevalent in women. VTE occurs in association with hospitalization or nursing home residence about 60% of the time, active cancer about 20% of the time, and a central venous catheter or transvenous pacemaker about 9% of the time.

• #7 Deep vein thrombosis – Wikipedia

  https://en.wikipedia.org/wiki/Deep_vein_thrombosis

  DVT occurs in the upper extremities in about 4-10% of cases, with an incidence of 0.4-1.0 people out of 10,000 a year. A minority of upper extremity DVTs are due to Paget-Schroetter syndrome, also called effort thrombosis, which occurs in 1-2 people out of 100,000 a year, usually in athletic males around 30 years of age or in those who do significant amounts of overhead manual labor.

• #8

  https://link.springer.com/article/10.1007/s11239-015-1311-6

  The estimated average annual incidence rate of overall VTE among persons of European ancestry ranges from 104 to 183 per 100,000 person-years; overall VTE incidence is similar to that of stroke. […] Overall VTE incidence may be higher in African-Americans and lower in Asians, and may differ among African-Americans by United States region. […] VTE is predominantly a disease of older age; VTE is rare prior to late adolescence. […] Incidence rates increase markedly with age for both men and women and for both DVT and PE. […] The overall age-adjusted incidence rate is higher for men than women. […] Data on trends in VTE incidence are limited; overall VTE incidence rates as well as incidence rates for PE DVT and DVT alone either remained relatively constant or increased for the period, 1981-2000, with a significant increase in the overall VTE incidence rate from 2001 to 2009, mostly due to an increasing incidence of PE DVT.

• #9 Epidemiology and Risk Factors for Venous Thromboembolism | Oncohema Key

  https://oncohemakey.com/epidemiology-and-risk-factors-for-venous-thromboembolism/

  The estimated average annual incidence rate of VTE among persons of European ancestry ranges from 104 to 183 per 100,000 person-years. […] Using the age- and sex-specific incidence rates for the 5-year time period, 1991 to 1995, projected to the 2000 United States white population, at least 260,000 new cases of VTE occur among whites in the United States annually. […] VTE is predominantly a disease of older age. […] Incidence rates increase markedly with age for both men and women (FIGURE 82.1) and for both DVT and PE (FIGURE 82.2). […] Overall, survival after VTE is worse than expected, and survival after PE is much worse than after DVT alone (Table 82.1). […] VTE recurs frequently; about 30% of patients develop recurrence within the next 10 years. […] Independent predictors of recurrence include increasing patient age and body mass index,

• #9 Epidemiology and Risk Factors for Venous Thromboembolism | Oncohema Key

  https://oncohemakey.com/epidemiology-and-risk-factors-for-venous-thromboembolism/

  Among cancer patients, the hazard of VTE recurrence is significantly increased with lung, gastrointestinal, or genitourinary (uterus, kidney, ovary, testicle, bladder, prostate) cancer, and with extensive or moderately extensive cancer disease. […] Secondary prophylaxis should be considered for patients with incident PE, especially those with chronic heart and/or lung disease causing reduced cardiopulmonary functional reserve; it is these patients who are most likely to die from recurrent PE.

• #10 Epidemiology and Risk Factors for Venous Thrombosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2020806/

  Venous thrombosis, including deep vein thrombosis and pulmonary embolism, occurs at an annual incidence of about 1 per 1000 adults. Rates increase sharply after around age 45 years, and are slightly higher in men than women in older age. […] Venous thrombosis, comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs with an incidence of approximately 1 per 1000 annually in adult populations. Rates are slightly higher in men than women. […] Venous thrombosis is a disease of aging, with a low rate of about 1 per 10,000 annually before the fourth decade of life, rising rapidly after age 45 years, and approaching 56 per 1000 annually by age 80. […] There are also differences in incidence of diagnosed venous thrombosis among ethnic groups with rates lower, in the United States, in Asians, Pacific Islanders and Hispanics than in whites, and with some studies reporting an approximate 25% higher rate in African-Americans.

• #10 Epidemiology and Risk Factors for Venous Thrombosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2020806/

  An understanding of the risk factors for venous thrombosis is necessary in order to maximize the prevention of this disease in high risk individuals and groups of patients. […] The major risk factors for thrombosis are listed in table 1 and include endogenous patient characteristics such as obesity and genetic factors, and triggering factors such as surgery, immobility or pregnancy. […] Most hospitalized patients have risk factors for venous thrombosis, such as immobility, cancer, infection and surgery. Up to 20% of patients admitted to a medical service will have thrombosis and up to 40% admitted to a surgical service. […] Cancer patients have an increased risk of thrombosis due to a combination of factors, as recently reviewed. Tumor cells activate coagulation, tumors can compress veins causing stasis and cancer patients are exposed to hospitalization, surgery and chemotherapy, which all increase their risk.

• #10 Epidemiology and Risk Factors for Venous Thrombosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2020806/

  The high absolute rate of thrombosis in cancer patients suggests that anticoagulant prophylaxis would be beneficial, particularly in high-risk situations like surgery. […] Any type of travel has the potential to increase the risk of venous thromboembolism; duration of travel is a key factor. Travel by air, car, train or bus for 4 or more hours all increase the risk by about 2-fold for several weeks after travel. […] Over the past 20 years several gene variants have been identified as risk factors for venous thrombosis. […] Higher D-dimer is also a risk factor for first venous thrombosis in otherwise healthy individuals. […] Venous thrombosis is often a chronic condition, with recurrence rates estimated at 57% annually after a first episode. The risk is highest among those whose initial episode was associated with cancer, and lowest among those whose initial episode was associated with a temporary risk factor such as surgery.

• #11 Epidemiology of DVT (summarized from ESVS guidelines statement 2021)

  https://www.veinsveinsveins.com/newsDetail/319/epidemiology-of-dvt-(summarized-from-esvs-guidelines-statement-2021)/

  31Jan Epidemiology of deep vein thrombosis from a summary put together by the European Society of Vascular Surgery in their guidelines statement published in 2021. These key points are summarized and some are taken verbatim from the manuscript: 1. The incidence of DVT is slightly greater in women aged 20 45 years, but men have a higher incidence between 45 and 60 years of age. 2. The incidence is higher for males for all age groups if female specific risk factors (oral contraceptives and pregnancy) are excluded. 3. The incidence of DVT increases two-fold per 10 year age increase. 4. At least one in 12 middle aged adults will develop either DVT and/or pulmonary embolism (PE) in their remaining lifetime. 5. Sixty percent of all venous thromboembolism (VTE) events occur in patients aged 65 years. 6. African Americans have a higher incidence of DVT than Caucasians and Native Americans. 7. Asians (China and Korea) have a lower incidence of DVT than Caucasians and Native Americans. 8. A seasonal variation occurs, with a higher incidence of VTE in the winter, peaking in February. 9. The rate of recurrent VTE is around 10% the first year and 30% after 5 8 years for patients with unprovoked DVT with an unidentified triggering factor. 10. The annual incidence of VTE has not changed in the last two to three decades, although the prevalence of cancer, major surgery, trauma, and obesity has increased, and the widespread availability of improved diagnostic modalities with computed tomography (CT) and magnetic resonance imaging (MRI) leading to increased detection of incidental VTE in patients with cancer. […] Dr Karamanoukian’s comment: these summaries of the epidemiology of deep vein thrombosis are certainly very interesting and clinically relevant to patients and vein specialists.

• #12 Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1911303-overview

  DVT usually affects individuals older than 40-45 years. The incidence of VTE increases with age in both sexes. The age-standardized incidence of first-time VTE is 1.92 per 1000 person-years. […] The male-to-female ratio is 1.2:1, indicating that males have a higher risk of DVT than females. […] From a US demographic viewpoint, Asians, Pacific Islanders, and Hispanic populations have a lower risk compared to White patients, whereas Black individuals have a 25% higher risk of VTE. Among patients with coronavirus disease 2019 (COVID-19), Black individuals also had a much higher risk of VTE relative to their White or Asian cohorts.

• #12 Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1911303-overview

  Deep venous thrombosis (DVT) and thromboembolism remain a common cause of morbidity and mortality in bedridden or hospitalized patients, as well as generally healthy individuals. The exact incidence of DVT is unknown because most studies are limited by the inherent inaccuracy of clinical diagnosis. Existing data that probably underestimate the true incidence of DVT suggest that about 80 cases per 100,000 population occur annually. Approximately 1 person in 20 develops a DVT in the course of his or her lifetime. About 600,000 hospitalizations per year occur for DVT in the United States. […] In elderly persons, the incidence is increased by four-fold. The in-hospital case-fatality rate for venous thromboembolism (VTE) is 12%, rising to 21% in the geriatric population. In hospitalized patients, the incidence of venous thrombosis is considerably higher and varies from 20% to 70%. Venous ulceration and venous insufficiency of the lower leg, which are long-term complications of DVT, affect 0.5% of the entire population. Extrapolation of these data reveals that as many as 5 million people have venous stasis and varying degrees of venous insufficiency.

• #13 Incidence of proximal deep vein thrombosis in medical critical care patients | Thrombosis Journal | Full Text

  https://thrombosisjournal.biomedcentral.com/articles/10.1186/s12959-022-00363-5

  Approximately 13-31% of medical critical care patients develop deep vein thrombosis (DVT). […] The objectives of this study were to assess the prevalence and incidence proportion of proximal DVT in Thai medical critical care patients not receiving thrombosis prophylaxis. […] Of the 158 patients enrolled in the study, 25 had proximal DVT (15.8%). […] Thus, the prevalence at the beginning of the study was 5.7% (95%CI 2.6-10.5) and the incidence proportion was 10.1% (95%CI 5.9-15.9). […] Routine thromboprophylaxis is not used in our institution and the prevalence and incidence proportion of proximal DVT in Asian medical critical care patients were both substantial. […] The incidence proportion of proximal lower limb DVT among Asian medical critical care patients without thromboprophylaxis was slightly lower than reported for Caucasian populations.

• #14 Deep Vein Thrombosis (DVT) | Doctor

  https://patient.info/doctor/deep-vein-thrombosis-pro

  The annual incidence of symptomatic VTE is 1-2 per 1,000, of which around two-thirds are a DVT. […] The incidence of DVT during pregnancy is approximately 1 in 1,000 live births. […] In people who are critically ill, an incidence of up to 37.2% has been reported. […] Major risk factors for VTE include a prior history of DVT, age over 60 years, surgery, obesity, prolonged travel, acute medical illness, cancer, immobility, thrombophilia and pregnancy/puerperium. […] One study found that 50-70% of patients had readily identifiable risk factors.

• #15 DVT (Deep Vein Thrombosis) – Oxford Medical Education

  https://oxfordmedicaleducation.com/haematology/dvt-deep-vein-thrombosis/

  Age-standardised incidence of 2 per 1000 person years in adults 45 yrs. […] The incidence in hospital inpatients is much higher, particularly those undergoing surgery. Prior to the widespread use of prophylactic LMWH: Rates of asymptomatic DVT in surgical admissions were estimated at 10% […] Approx 4% of medical inpatients developed a symptomatic DVT by day 21. […] In the Million Women study, which occurred after the adoption of VTE prophylaxis, rates of VTE were 70-fold higher in patients within 6 weeks of an inpatient operation, than in those not undergoing surgery. […] DVT is important because it can cause pulmonary embolism, which is thought to account for 40,000 hospital deaths each year in the UK.

• #16 Risk factors for deep vein thrombosis of lower extremities in Sudanese | VHRM

  https://www.dovepress.com/risk-factors-for-deep-vein-thrombosis-of-lower-extremities-in-sudanese-peer-reviewed-fulltext-article-VHRM

  Deep vein thrombosis (DVT) occurs at an incidence ranging from ~45 to 117 in 100,000 adults per year. African Americans have higher rates of DVT than Caucasians. The prevalence of DVT in Africans varied between 380 and 448 per 100,000 births per year in pregnant and postpartum women, and between 2.4% and 9.6% in postoperative patients. DVT is a major cause of morbidity and mortality in older adults and one of the leading causes of maternal mortality in the western world. Venous thrombosis is a reproductive health risk for women. During pregnancy, the risk of venous thrombosis increases by up to 5-fold, and the risk further increases by 60-fold postpartum. Furthermore, a large number of women worldwide are at a high risk of developing venous thrombosis because of the use of oral contraceptives or hormone replacement therapy (HRT). DVT is uncommon among patients younger than 40 years of age, and more common in women than in men amid reproductive age, which supports the role of hormonal contraceptives and pregnancy in developing DVT during this period of life. The incidence of venous thrombosis is ~1 in 1000 pregnancies. Additionally, pregnant women are 6- to 10-fold more likely to develop DVT than nonpregnant women of the same age. Among pregnant women, the frequency of thrombosis is similar in each of the three trimesters and is increased during the postpartum period.

• #17 Deep Vein Thrombosis and Pulmonary Embolism | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/air-land-sea/deep-vein-thrombosis-and-pulmonary-embolism

  Deep vein thrombosis (DVT) is a condition in which a blood clot develops in the deep veins, usually in the lower extremities. […] The annual incidence of VTE in the general population is estimated to be 0.1% but is greater in subpopulations with risk factors for VTE. […] The actual incidence of travel-related VTE is difficult to determine because there is no national surveillance for VTE and no consensus on the definition of travel-associated VTE, particularly regarding duration of travel and period of observation after travel. […] Studies estimating the incidence of air travel-associated VTE have used various criteria to determine risk factors and outcomes. […] In general, the incidence of air travel-associated VTE appears to be low. […] Studies indicate that long-distance air travel might increase a person’s overall risk for VTE by 2- to 4-fold, but the data are inconsistent.

• #18 Deep vein thrombosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/deep-vein-thrombosis?embed_domain=hackmd.io%2525252F%25252540yIPUAFeCSL2JsU8smR5nJQ%2525252Fbnjhjgjghjghjghfavicon.icoradiopaedia-icon-144.pngradiopaedia-icon-144.png&lang=us

  Deep vein thrombosis (DVT) most commonly occurs in the lower limbs; however, it is not uncommon in the upper limb and neck deep veins. […] 1.6 new cases per 1000 per year. […] 2.5-5% of the population is affected. […] 50% have long-term symptoms of post-thrombotic syndrome. […] 6% of DVT patients report eventual venous ulcers (0.1% of the general population).

• #19 Deep vein thrombosis: pathogenesis, diagnosis, and medical management – Stone – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/16872/html

  Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide. Venous thromboembolism (VTE), which includes DVT and pulmonary embolism (PE), affects an estimated 1 per 1,000 people and contributes to 60,000-100,000 deaths annually. […] The incidence of VTE is estimated to be 1 per 1,000 people annually, with DVT accounting for approximately two-thirds of these events. […] The 30-day mortality rate exceeds 3% in patients with DVT who are not anticoagulated, and this mortality risk increases 10-fold in patients who develop PE. […] DVT is diagnosed with increasing precision using the Wells criteria, D-dimer assay, and an expanding array of imaging modalities including US, CT, and MR venography. […] The treatment of DVT has traditionally included VKAs such as warfarin with heparin or fractionated heparin bridging.

• #20 Venous Thromboembolism – Diagnosis and Management – Province of British Columbia

  https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/venousthrombembolism

  VTE affects at least one in 1000 individuals each year and is the third most common cause of vascular death worldwide. VTE most commonly manifests as DVT in the legs and/or PE. […] Early diagnosis and treatment reduce VTE morbidity and mortality.

• #21 Surveillance for Deep Vein Thrombosis and Pulmonary Embolism

  https://www.periodicos.capes.gov.br/index.php/acervo/buscador.html?task=detalhes&id=W56050800

  Deep vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), affect an estimated 900,000 people in the U.S. each year, resulting in several hundred thousand hospitalizations and about 300,000 deaths. […] Despite this substantial public health burden, no systematic collection of VTE-related morbidity and mortality data exists in the U.S. […] The limited scope of the available data has raised the question of whether a systematic surveillance system for VTE should be established. […] The workshop concluded that (1) improved utilization in clinical practice of existing, proven-effective preventive measures is critical to reducing the disease burden from VTE; (2) systematic surveillance of DVT and PE is needed to provide nationally representative data on the prevalence and annual incidence of DVT and PE in the U.S.; (3) tracking and documenting changes in the incidence of DVT and PE through systematic surveillance will be important to enhance prevention efforts; and (4) the CDC should convene a second group of experts to advise the agency in detail on the strengths, weaknesses, and feasibility of possible approaches to systematic surveillance for DVT and PE.

• #22 Surveillance for Deep Vein Thrombosis and Pulmonary Embolism | CoLab

  https://colab.ws/articles/10.1016%2Fj.amepre.2010.01.010

  Deep vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), affect an estimated 900,000 people in the U.S. each year, resulting in several hundred thousand hospitalizations and about 300,000 deaths. […] Despite this substantial public health burden, no systematic collection of VTE-related morbidity and mortality data exists in the U.S. […] The workshop concluded that (1) improved utilization in clinical practice of existing, proven-effective preventive measures is critical to reducing the disease burden from VTE; (2) systematic surveillance of DVT and PE is needed to provide nationally representative data on the prevalence and annual incidence of DVT and PE in the U.S.; (3) tracking and documenting changes in the incidence of DVT and PE through systematic surveillance will be important to enhance prevention efforts; and (4) the CDC should convene a second group of experts to advise the agency in detail on the strengths, weaknesses, and feasibility of possible approaches to systematic surveillance for DVT and PE.

• #23

  https://journals.lww.com/md-journal/fulltext/2023/10270/ultrasound_surveillance_for_deep_venous_thrombosis.49.aspx

  Studies have shown routine ultrasound surveillance (RUSS) will facilitate deep vein thrombosis (DVT) detection in patients with trauma and reduce the subsequent incidence of pulmonary embolism (PE); however, the findings were inconsistent. […] The RUSS efficacy in adults with trauma at high risk for venous thromboembolism showed that it increases DVT detection, decreases PE incidence, and shortens the time to DVT diagnosis, with an uncertain impact on mortality. […] Major trauma is a significant risk factor for deep vein thrombosis (DVT) and pulmonary embolism (PE). The incidence of venous thromboembolism (VTE) varies among patients with trauma. […] The RUSS group in the included RCT (N = 1989) was associated with increased rates of in-hospital distal DVT (RR, 15.48; 95% CI, 7.62 31.48; low certainty) and in-hospital proximal DVT (RR, 2.37; 95% CI, 1.04 5.39; very low certainty).

• #23

  https://journals.lww.com/md-journal/fulltext/2023/10270/ultrasound_surveillance_for_deep_venous_thrombosis.49.aspx

  Evidence from observational studies (four studies, N = 10,642) suggested higher odds of DVT detection using RUSS (OR, 4.87; 95% CI, 3.137.57; very low certainty). […] In the included RCT, no difference was observed between the in-hospital mortality (RR, 0.73; 95% CI, 0.441.22; very low certainty) and 90-day mortality (RR, 0.83; 95% CI, 0.591.18; low certainty) in both the RUSS and no-RUSS groups. […] The clinical efficacy of RUSS for post-trauma VTE prophylaxis is still debated. Some guidelines recommend RUSS to detect asymptomatic DVT in trauma patients at high risk of VTE, but they do not agree on the associated risk or the effect of RUSS on PE rates. […] RUSS may result in improved DVT detection rates, fewer cases of PE, shorter times to DVT diagnosis, and uncertain effects on mortality.

• #24

  https://journals.lww.com/md-journal/fulltext/2018/09070/surveillance_or_no_surveillance_for_deep_venous.104.aspx

  Surveillance ultrasounds in critically ill patients detect many deep venous thrombi (DVTs) that would otherwise go unnoticed. However, the impact of surveillance for DVT on mortality among critically ill patients remains unclear. […] Data from recent RCTs in critically ill patients that conducted surveillance for DVT reported much higher DVT incidence that what has been traditionally reported in nonsurveillance studies. […] By earlier identification of silent DVTs, surveillance may reduce the incidence of PE and consequently reduce morbidity and mortality in critically ill patients. […] In the Pneumatic CompREssion for Preventing VENous Thromboembolism (PREVENT) trial, we will examine the effectiveness of adjunct intermittent pneumatic compression (IPC) use with pharmacologic thromboprophylaxis compared to pharmacologic thromboprophylaxis alone on the incidence of proximal lower extremity DVT in critically ill patients.

• #25 Incidence of deep vein thrombosis through an ultrasound surveillance protocol in patients with COVID-19 pneumonia in non-ICU setting: A multicenter prospective study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251966

  The aim of this study was to assess the incidence of deep vein thrombosis (DVT) of the lower limbs, using serial compression ultrasound (CUS) surveillance, in acutely ill patients with COVID-19 pneumonia admitted to a non-ICU setting. […] Over a two-month period, 227 consecutive patients with moderate-severe COVID-19 pneumonia were enrolled. The incidence of DVT was 13.7% (6.2% proximal, 7.5% distal), mostly asymptomatic. […] The incidence of DVT in acutely ill patients with COVID-19 pneumonia is relevant. A surveillance protocol by serial CUS of the lower limbs is useful to timely identify DVT that would go otherwise largely undetected. […] In this multicenter study, a surveillance protocol with systematic ultrasonography of the lower limbs in patients admitted to IMUs with COVID-19 pneumonia showed an overall incidence of DVT of 13.7%, 6.2% in proximal (6.2%) and 7.5% in distal venous district.

• #25 Incidence of deep vein thrombosis through an ultrasound surveillance protocol in patients with COVID-19 pneumonia in non-ICU setting: A multicenter prospective study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251966

  These data taken together suggest a significant incidence of lower limb DVT in patients with COVID-19 pneumonia in non-ICU setting despite anticoagulation. […] A peak D-dimers value of 2000 ng/mL was the most accurate cut-off to identify patients with DVT with a high negative predictive value and significant sensitivity. […] The findings of this multicenter study confirm the high incidence of lower limb DVT despite anticoagulation in patients with COVID-19 pneumonia admitted to Internal Medicine wards.

• #26 The incidence of deep vein thrombosis detected by routine surveillance ultrasound in neurosurgery patients receiving dual modality prophylaxis.

  https://jdc.jefferson.edu/petfp/25/

  The optimal method of thromboprophylaxis and the value of screening ultrasonography for detection of deep venous thrombosis (DVT) in neurosurgery patients remains unclear. […] A retrospective review of 7,298 ultrasound studies carried out on 2,593 patients over 4 years at a university neurosurgical hospital was conducted. There was a 7.4% incidence of proximal lower extremity DVT and a 9.7% total incidence including distal DVT. […] The hospital protocol of biweekly screening ultrasound and dual modality prophylaxis for neurosurgery patients resulted in a proximal DVT incidence consistent with that demonstrated by previous studies of standardized dual modality prophylaxis, and higher than that demonstrated in previous studies that employed ultrasound screening protocols.

• #27 Deep Venous Thrombosis | Nutrition Guide for Clinicians

  https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342012/all/Deep_Venous_Thrombosis

  Deep venous thrombosis (DVT) and acute pulmonary embolism (PE) are both integrated into a single disorder, venous thromboembolism (VTE). There are as many as 900,000 hospitalizations per year in the United States due to VTE, and as many as 60,000 to 300,000 deaths. […] DVT occurs most often in the lower extremities but can also develop in the upper extremities, especially in patients with indwelling central venous catheters. DVT most commonly affects the iliac, popliteal, and femoral veins. […] PE, due to embolization of a DVT, is the second-leading preventable cause of hospital mortality. […] A previous history of a thromboembolic event is a major indicator of risk. […] Risk increases with age, due in part to increased comorbidities. […] Major surgeries (e.g., orthopedic, thoracic, abdominal, and genitourinary) pose the greatest risk, but individualized risk assessments should be done to determine if minor surgeries also require prophylaxis.

• #28 Epidemiology of deep venous thrombosis in US emergency departments during an 8-year period

  http://www.ceemjournal.org/journal/view.php?number=581

  Epidemiology of deep venous thrombosis in US emergency departments during an 8-year period […] Deep vein thrombosis (DVT) is a significant cause of morbidity and mortality worldwide, accounting for substantial healthcare utilization. However, management strategies have evolved, and current data on the incidence, admission rates, and medical management of DVT in the emergency department (ED) setting are needed. […] Of 190,144,463 total ED encounters, 368,044 (0.2%) were due to DVT. Among the DVT cases, 119,986 patients (32.6%) were admitted, at a stable rate during the study period. Apixaban was the most prescribed anticoagulant (40.3%), followed by rivaroxaban (28.3%), enoxaparin (7.9%), warfarin (3.6%), and dabigatran (0.3%). Use of apixaban increased from 12.4% in 2016 to 56.2% in 2023. Lower extremity DVTs accounted for 88.5% of cases, with a 32.1% admission rate, whereas upper extremity DVTs accounted for 11.7% of cases, with a 37.0% admission rate.

• #28 Epidemiology of deep venous thrombosis in US emergency departments during an 8-year period

  http://www.ceemjournal.org/journal/view.php?number=581

  This study provides a summary of DVT presentation and management in US EDs during an 8-year period. The findings highlight stable incidence rates, reduced admission rates compared with historical data, and a significant shift toward the use of direct oral anticoagulants, particularly apixaban, for outpatient management. These trends underscore the importance of evidence-based practices and ongoing research to optimize DVT management and improve patient outcomes. […] From 2016 to 2023, deep venous thrombosis had a stable incidence rate, reduced admissions compared with historical data, and a shift toward the use of direct oral anticoagulants, particularly apixaban, for outpatient management. […] Deep vein thrombosis (DVT) is a significant cause of morbidity and mortality worldwide, with an estimated annual incidence of 5 to 10 per 10,000 persons per year in the general population. Among emergency department (ED) patients, the rate might be higher, with older literature estimating that 0.1% to 0.2% of ED visits were due to DVT. The condition accounts for substantial healthcare utilization, particularly in the ED setting, where timely diagnosis and management are crucial to prevent adverse outcomes, particularly pulmonary embolism (PE).

• #28 Epidemiology of deep venous thrombosis in US emergency departments during an 8-year period

  http://www.ceemjournal.org/journal/view.php?number=581

  Another notable finding of our study is the stable admission rate for isolated extremity DVT, with approximately one-third of patients (32.6%) being admitted. This rate is significantly lower than in historical data: admission rates were as high as 52% in the early 2000s. The reduction in admissions can likely be attributed to a few factors, including greater coordination of home health care and widespread adoption of DOACs, which facilitate the outpatient treatment of uncomplicated DVT. […] In summary, our study provides a summary of DVT presentations and management across many US EDs during an 8-year period. We identified increased incidence rates and a significant shift toward outpatient management (compared with prior work) that is facilitated by the use of DOACs, particularly apixaban. These findings emphasize the need for ongoing research and continuous evaluation of clinical practices to ensure optimal outcomes for patients with DVT. Future studies should focus on the long-term outcomes of patients managed with these new approaches.

• #29 Below-knee deep vein thrombosis (DVT): diagnostic and treatment patterns – Fleck – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/17502/html

  Guidelines are lacking for isolated below-knee deep vein thrombosis (BKDVT). The American College of Chest Physicians (ACCP) suggests anticoagulation only if symptoms are severe, otherwise surveillance with follow-up ultrasound in 2 weeks is recommended. […] Most of what is known about the natural history of BKDVT is based on observational studies, with a wide range of estimates on its prevalence and the risk of clot propagation and embolism. […] Overall, there are an estimated 300,000 cases of BKDVT diagnosed each year in the United States. […] Most cases of BKDVT resolve spontaneously without anticoagulation. […] Surveillance ultrasound is not commonly recommended and likely underutilized. […] Our study did observe a significant proportion of patients who presented with concurrent PE (17.6% of the sample), although this likely overestimates the overall risk of embolization. […] In conclusion, there remains confusion among physicians in how to best manage BKDVT because of limited data and practice guidelines.

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