Zakrzepica żył głębokich
Rokowania, prognozy i postęp choroby

Zakrzepica żył głębokich (DVT) jest poważnym schorzeniem, którego rokowanie zależy od wielu czynników, w tym historii żylaków, obustronnej lokalizacji zakrzepicy oraz czasu stosowania terapii przeciwzakrzepowej. Zespół pozakrzepowy (PTS) występuje u około 54,1% pacjentów z DVT, a jego rozwój jest szczególnie częsty w ciągu pierwszych 2 lat od incydentu, obniżając jakość życia na poziomie porównywalnym z przewlekłymi chorobami takimi jak cukrzyca czy niewydolność serca. COVID-19 znacząco zwiększa ryzyko nasilenia DVT (HR: 2,311; P=0,0018), zwłaszcza u pacjentów po standardowej trzymiesięcznej terapii przeciwzakrzepowej (HR: 5,667; P=0,0001), co wskazuje na konieczność przedłużonego leczenia przeciwzakrzepowego w tej grupie. U pacjentów onkologicznych, szczególnie z zaawansowanym niedrobnokomórkowym rakiem płuca, częstość DVT wynosi 4-17%, a profilaktyka antykoagulacyjna jest zalecana w celu poprawy przeżywalności i zmniejszenia ryzyka VTE.

  1. Prognoza w zakrzepicy żył głębokich (DVT)
    1. Długoterminowe powikłania
    2. Czynniki wpływające na rokowanie
    3. Wpływ COVID-19 na przebieg DVT
    4. Nowotwór a DVT
  2. Narzędzia diagnostyczne i predykcyjne
    1. Modele uczenia maszynowego
    2. Reguły predykcji klinicznej
  3. Monitorowanie leczenia i długoterminowa opieka
    1. Czas trwania antykoagulacji
  4. Najważniejsze czynniki rokownicze
    1. Kolejne rozdziały

Prognoza w zakrzepicy żył głębokich (DVT)

Zakrzepica żył głębokich (DVT) stanowi poważny problem zdrowotny, którego konsekwencje mogą być odczuwalne zarówno w krótko-, jak i długoterminowej perspektywie. Skuteczne przewidywanie przebiegu choroby i ocena rokowania mają kluczowe znaczenie dla optymalizacji strategii leczenia i poprawy wyników klinicznych.12

Długoterminowe powikłania

Zespół pozakrzepowy (PTS) jest jednym z najczęstszych długoterminowych powikłań zakrzepicy żył głębokich kończyn dolnych. Badania pokazują, że około 54,1% pacjentów z DVT doświadcza objawów zespołu pozakrzepowego. Główne czynniki wpływające na stopień nasilenia PTS obejmują historię żylaków oraz obustronną zakrzepicę żył głębokich kończyn dolnych.3 PTS rozwija się u około jednej czwartej przypadków objawowej proksymalnej DVT, przy czym większość przypadków pojawia się w ciągu pierwszych 2 lat od wystąpienia zakrzepicy.4

Rozwój zespołu pozakrzepowego i przewlekłej niewydolności żylnej może znacząco obniżyć jakość życia pacjentów, w stopniu porównywalnym do przewlekłych chorób takich jak cukrzyca, przewlekła obturacyjna choroba płuc czy niewydolność serca.5 DVT może również prowadzić do zatorowości płucnej (PE), która jest główną przyczyną możliwej do uniknięcia śmiertelności wewnątrzszpitalnej i powoduje nawet 100 000 zgonów rocznie w Stanach Zjednoczonych.6

Czynniki wpływające na rokowanie

Analiza statystyczna wskazuje, że wynik leczenia zakrzepicy jest istotnym czynnikiem wpływającym na punktację PTS (1-4 punkty, P<0,05). Na stopień nasilenia PTS wpływa głównie historia żylaków i zakrzepica żył głębokich kończyn dolnych. Czas przyjmowania leków przeciwzakrzepowych również wpływa na wynik leczenia zakrzepicy (P<0,05), zwłaszcza wśród pacjentek płci żeńskiej.7

Przegląd systematyczny wskazuje, że potencjalnymi czynnikami predykcyjnymi progresji zakrzepicy powierzchownej do DVT i/lub PE są: podeszły wiek, płeć męska, historia żylnej choroby zakrzepowo-zatorowej (VTE), nowotwór oraz brak żylaków.89

Wpływ COVID-19 na przebieg DVT

COVID-19 został potwierdzony jako istotny czynnik ryzyka zakrzepicy żył głębokich. Badania wykazały, że pacjenci leczeni w 2022 roku wykazywali wyższą częstość nasilenia DVT w porównaniu do pacjentów z 2021 roku (HR: 2,311, P=0,0018). W kohortach dopasowanych metodą PSM, ryzyko nasilenia DVT było 3,182 razy wyższe w grupie pacjentów z COVID-19 w porównaniu z grupą kontrolną (P=0,0001).10

Ekspozycja na COVID-19 zwiększała ryzyko nasilenia DVT wśród pacjentów, którzy ukończyli trzymiesięczną terapię przeciwzakrzepową (HR: 5,667, P=0,0001), ale nie zwiększała częstości występowania wśród pacjentów, którzy ukończyli dłuższą niż trzymiesięczną terapię przeciwzakrzepową (HR: 1,198, P=0,683). Przedłużona terapia przeciwzakrzepowa została zidentyfikowana jako skuteczne podejście do poprawy kontroli DVT wśród pacjentów z COVID-19.1112

Nowotwór a DVT

Żylna choroba zakrzepowo-zatorowa (VTE) stanowi powszechny problem u pacjentów z chorobą nowotworową, a częstość jej występowania rośnie, szczególnie u pacjentów z rakiem płuc. Częstość występowania DVT u pacjentów z nowotworami szacuje się na 4-17%. W porównaniu z pacjentami z nowotworem bez zakrzepicy, pacjenci zarówno z zakrzepicą, jak i nowotworem mają niższy wskaźnik przeżywalności.13

Zaawansowane stadium nowotworu zostało potwierdzone jako silny czynnik predykcyjny VTE u pacjentów z niedrobnokomórkowym rakiem płuca (NSCLC). Zaleca się profilaktyczne stosowanie antykoagulantów u pacjentów z zaawansowanym rakiem płuc. Ponadto zaleca się ocenę ryzyka VTE przed rozpoczęciem chemioterapii.14

Narzędzia diagnostyczne i predykcyjne

Modele uczenia maszynowego

Rozwijane są nowoczesne metody monitorowania i prognozowania DVT z wykorzystaniem algorytmów uczenia maszynowego. Przykładowo, w badaniu dotyczącym pooperacyjnej DVT po laparoskopii ginekologicznej, model Random Forest (RFM) osiągnął optymalną wydajność przewidywania DVT, z wartościami AUC wynoszącymi 0,851 (95% CI: 0,793-0,909) i 0,862 (95% CI: 0,804-0,920) odpowiednio w zestawach treningowych i walidacyjnych.15

Implikacje prognostyczne modelu predykcyjnego DVT mogą ułatwić bardziej responsywne systemy opieki zdrowotnej, które są korzystne dla pacjentów z wysokim ryzykiem DVT poprzez wczesną identyfikację, natychmiastową interwencję oraz intensywną opiekę i monitorowanie. Połączenie zaawansowanych algorytmów ML i cech klinicznych może terminowo i dokładnie klasyfikować pacjentów z wysokim ryzykiem DVT, co może pomóc klinicystom w terminowej identyfikacji DVT i zapewnieniu odpowiedniej opieki klinicznej w celu wspierania rekonwalescencji pooperacyjnej i poprawy rokowania pacjenta.16

Innym przykładem jest system AutoDVT, który wykorzystuje uczenie maszynowe do analizy obrazów USG w celu identyfikacji DVT. System ten uczy się głównie z danych zdrowych ochotników, jak wygląda zdrowe naczynie, i wykorzystuje tę wiedzę do identyfikacji pacjentów podejrzewanych o DVT. Badania pokazują potencjał systemu wspieranego przez ML wykorzystującego badanie ultrasonograficzne do identyfikacji DVT w populacjach klinicznych o wysokiej przepustowości i na poziomie podstawowej opieki zdrowotnej.1718

Reguły predykcji klinicznej

Prawidłowe stosowanie reguł predykcji klinicznej (CPRs) dla żylnej choroby zakrzepowo-zatorowej w podstawowej opiece zdrowotnej wiąże się z wysoką skutecznością i akceptowalnie niskim wskaźnikiem niepowodzeń. Co ważne, w prawie jednej czwartej przypadków CPRs były nieprawidłowo stosowane, co skutkowało niższą skutecznością i wyższym wskaźnikiem niepowodzeń. Takie nieprawidłowe stosowanie CPRs było częstsze w obecności współistniejącej niewydolności serca.19

W badanej populacji ogólny wskaźnik niepowodzeń obu CPRs wynosił 1,8% (95% CI 1,02 do 3,06), a ogólna skuteczność 53% (95% CI 50,4 do 55,5). Wskaźnik niepowodzeń wzrósł z 1,51% (95% CI 0,77 do 2,86) przy prawidłowym stosowaniu CPR do 3,31% (95% CI 1,07 do 8,76) przy nieprawidłowym stosowaniu CPR, a skuteczność spadła z 58,1% (95% CI 55,2 do 61,0) do 35,7% (95% CI 30,6 do 41,1).20

Monitorowanie leczenia i długoterminowa opieka

Rozpad skrzepliny w DVT może trwać od kilku miesięcy do roku, dlatego pacjenci muszą kontynuować przyjmowanie leków przeciwzakrzepowych zgodnie z zaleceniami i nosić pończochy uciskowe do czasu, aż lekarz zaleci ich zaprzestanie. Często konieczne są badania krwi w celu upewnienia się, że pacjent otrzymuje odpowiednią dawkę leków przeciwzakrzepowych.21

Lekarz może zalecić wykonanie dodatkowych badań ultrasonograficznych w późniejszym terminie, aby sprawdzić, czy skrzeplina jest nadal w tym samym miejscu, czy się zmniejsza, czy też powiększa. Monitorowanie to jest istotne dla dostosowania strategii leczenia i zapobiegania długoterminowym powikłaniom.22

Większość przypadków zakrzepicy żył głębokich jest bezobjawowa i zwykle ustępuje samoistnie bez powikłań. Jednak ze względu na poważne potencjalne konsekwencje, takie jak zespół pozakrzepowy i zatorowość płucna, kluczowe jest odpowiednie monitorowanie i leczenie wszystkich zdiagnozowanych przypadków.23

Czas trwania antykoagulacji

Czas przyjmowania leków przeciwzakrzepowych jest istotnym czynnikiem wpływającym na wynik leczenia zakrzepicy. Jak wykazano w badaniach dotyczących wpływu COVID-19 na DVT, przedłużona terapia przeciwzakrzepowa (ponad trzy miesiące) znacząco zmniejsza ryzyko nasilenia zakrzepicy w porównaniu do standardowej trzymiesięcznej terapii.2425

W przypadku pacjentów z chorobą nowotworową i DVT, zaleca się profilaktyczne stosowanie antykoagulantów, szczególnie u pacjentów z zaawansowanym rakiem płuc. Wczesna diagnoza i profilaktyczne stosowanie antykoagulantów są sugerowane dla pacjentów z chorobą nowotworową w celu poprawy rokowania.26

Najważniejsze czynniki rokownicze

Podsumowując, główne czynniki wpływające na rokowanie w zakrzepicy żył głębokich obejmują:

  • Historia żylaków i obustronnej zakrzepicy żył głębokich kończyn dolnych27
  • Czas i skuteczność stosowania terapii przeciwzakrzepowej2829
  • Współistnienie COVID-19, szczególnie przy standardowej trzymiesięcznej terapii przeciwzakrzepowej3031
  • Obecność choroby nowotworowej, zwłaszcza w zaawansowanym stadium32
  • Podeszły wiek, płeć męska i historia żylnej choroby zakrzepowo-zatorowej3334
  • Prawidłowe stosowanie reguł predykcji klinicznej w diagnostyce i leczeniu35

Zrozumienie tych czynników i ich wpływu na przebieg choroby może pomóc w optymalizacji strategii leczenia, monitorowaniu odpowiedzi na leczenie i zapobieganiu długoterminowym powikłaniom zakrzepicy żył głębokich.

Kolejne rozdziały

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/1911303-overview
    Most cases of deep venous thrombosis (DVT) are occult and usually resolve spontaneously without complication. […] The principal long-term morbidity from DVT is postthrombotic syndrome, which complicates about a quarter of cases of symptomatic proximal DVT; most cases develop within 2 years afterward. […] The development of postthrombotic syndrome and chronic insufficiency may cause significant negative effects on quality of life comparable to chronic diseases, such as diabetes, obstructive lung disease, and heart failure. […] Pulmonary embolism (PE) is the leading cause of preventable in-hospital mortality. […] Death from DVT is attributed to massive PE, which causes as many as 100,000 deaths annually in the United States.
  • #2 Prognosis and Factors 4 to 10 Years After Deep Vein Thrombosis: A Long-Term Follow-up Cohort Study
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11375659/
    Post-thrombotic syndrome (PTS) is one of the most common long-term complications of lower extremity deep vein thrombosis (DVT). In our study, 54.1% of patients with DVT (271 of 501) experienced indications and manifestations of PTS. By statistical analysis, we found that the outcome of thrombosis was the influencing factor of PTS score (1-4 points, P.05). The grading of PTS was primarily influenced by the history of varicose veins and DVT in the lower extremities. The duration of taking antithrombotic drugs affected the outcome of thrombosis (P.05), especially among the female patients. The study found that the severity of thrombosis significantly influenced the PTS score (1-4 points), that is, PTS score 1, 2, 3, and 4 points were all affected by the outcome of thrombosis and the difference was statistically significant (P.05). The results of this study suggest that the history of varicose veins and DVT involvement in both lower limbs are important factors affecting PTS grading.
  • #3 Prognosis and Factors 4 to 10 Years After Deep Vein Thrombosis: A Long-Term Follow-up Cohort Study
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11375659/
    Post-thrombotic syndrome (PTS) is one of the most common long-term complications of lower extremity deep vein thrombosis (DVT). In our study, 54.1% of patients with DVT (271 of 501) experienced indications and manifestations of PTS. By statistical analysis, we found that the outcome of thrombosis was the influencing factor of PTS score (1-4 points, P.05). The grading of PTS was primarily influenced by the history of varicose veins and DVT in the lower extremities. The duration of taking antithrombotic drugs affected the outcome of thrombosis (P.05), especially among the female patients. The study found that the severity of thrombosis significantly influenced the PTS score (1-4 points), that is, PTS score 1, 2, 3, and 4 points were all affected by the outcome of thrombosis and the difference was statistically significant (P.05). The results of this study suggest that the history of varicose veins and DVT involvement in both lower limbs are important factors affecting PTS grading.
  • #4 Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/1911303-overview
    Most cases of deep venous thrombosis (DVT) are occult and usually resolve spontaneously without complication. […] The principal long-term morbidity from DVT is postthrombotic syndrome, which complicates about a quarter of cases of symptomatic proximal DVT; most cases develop within 2 years afterward. […] The development of postthrombotic syndrome and chronic insufficiency may cause significant negative effects on quality of life comparable to chronic diseases, such as diabetes, obstructive lung disease, and heart failure. […] Pulmonary embolism (PE) is the leading cause of preventable in-hospital mortality. […] Death from DVT is attributed to massive PE, which causes as many as 100,000 deaths annually in the United States.
  • #5 Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/1911303-overview
    Most cases of deep venous thrombosis (DVT) are occult and usually resolve spontaneously without complication. […] The principal long-term morbidity from DVT is postthrombotic syndrome, which complicates about a quarter of cases of symptomatic proximal DVT; most cases develop within 2 years afterward. […] The development of postthrombotic syndrome and chronic insufficiency may cause significant negative effects on quality of life comparable to chronic diseases, such as diabetes, obstructive lung disease, and heart failure. […] Pulmonary embolism (PE) is the leading cause of preventable in-hospital mortality. […] Death from DVT is attributed to massive PE, which causes as many as 100,000 deaths annually in the United States.
  • #6 Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/1911303-overview
    Most cases of deep venous thrombosis (DVT) are occult and usually resolve spontaneously without complication. […] The principal long-term morbidity from DVT is postthrombotic syndrome, which complicates about a quarter of cases of symptomatic proximal DVT; most cases develop within 2 years afterward. […] The development of postthrombotic syndrome and chronic insufficiency may cause significant negative effects on quality of life comparable to chronic diseases, such as diabetes, obstructive lung disease, and heart failure. […] Pulmonary embolism (PE) is the leading cause of preventable in-hospital mortality. […] Death from DVT is attributed to massive PE, which causes as many as 100,000 deaths annually in the United States.
  • #7 Prognosis and Factors 4 to 10 Years After Deep Vein Thrombosis: A Long-Term Follow-up Cohort Study
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11375659/
    Post-thrombotic syndrome (PTS) is one of the most common long-term complications of lower extremity deep vein thrombosis (DVT). In our study, 54.1% of patients with DVT (271 of 501) experienced indications and manifestations of PTS. By statistical analysis, we found that the outcome of thrombosis was the influencing factor of PTS score (1-4 points, P.05). The grading of PTS was primarily influenced by the history of varicose veins and DVT in the lower extremities. The duration of taking antithrombotic drugs affected the outcome of thrombosis (P.05), especially among the female patients. The study found that the severity of thrombosis significantly influenced the PTS score (1-4 points), that is, PTS score 1, 2, 3, and 4 points were all affected by the outcome of thrombosis and the difference was statistically significant (P.05). The results of this study suggest that the history of varicose veins and DVT involvement in both lower limbs are important factors affecting PTS grading.
  • #8 Predictive factors of clot propagation in patients with superficial venous thrombosis towards deep venous thrombosis and pulmonary embolism: a systematic review and meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/14/4/e074818
    Although the pooled estimates of the predictors high age, male sex, history of VTE, cancer and absence of varicose veins showed predictive potential in isolation, variability in study designs, lack of multivariable adjustment and high risk of bias prevent firm conclusions. […] The most reported predictive factors for DVT and/or PE progression in patients with SVT were high age, male sex, history of VTE, cancer and absence of varicose veins. […] This review contributes to the clinical knowledge on the natural prognosis of SVT, a prevalent but still understudied thrombotic condition. […] Predictors that might be useful in this setting include high age, male sex, history of VTE, cancer and absence of varicose veins, that all appear to increase the risk of clot propagation or progression to DVT or PE.
  • #9 Predictive factors of clot propagation in patients with superficial venous thrombosis towards deep venous thrombosis and pulmonary embolism: a systematic review and meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/14/4/e074818
    This is a systematic summary of 22 papers describing prognostic and cross-sectional clinical predictors in patients with SVT of clot propagation towards DVT and/or PE up to 3 March 2023. The most reported clinical predictors were high age, male sex, history of VTE, cancer and absence of varicose veins and these predictors show potential for further multivariable exploration.
  • #10 The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03036-3
    Coronavirus disease 2019 (COVID-19) has been proved as a significant risk factor for deep vein thrombosis (DVT) after several waves of pandemic. This study aims to further investigate impact of COVID-19 on prognosis of DVT following anticoagulation treatment. […] In 2022, patients exhibited higher incidence rates of DVT aggravation compared to those in 2021 (HR:2.311, P=0.0018). […] In PSM-matched cohorts, the risk for DVT aggravation was 3.182 times higher in COVID-19 group compared to the control group (P=0.0001). […] Exposure to COVID-19 increased the risk of DVT aggravation among patients who completed three months anticoagulant therapy (HR: 5.667, P=0.0001), but did not increase incidence rate among patients who completed more than three months anticoagulant therapy (HR:1.198, P=0.683).
  • #11 The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03036-3
    Coronavirus disease 2019 (COVID-19) has been proved as a significant risk factor for deep vein thrombosis (DVT) after several waves of pandemic. This study aims to further investigate impact of COVID-19 on prognosis of DVT following anticoagulation treatment. […] In 2022, patients exhibited higher incidence rates of DVT aggravation compared to those in 2021 (HR:2.311, P=0.0018). […] In PSM-matched cohorts, the risk for DVT aggravation was 3.182 times higher in COVID-19 group compared to the control group (P=0.0001). […] Exposure to COVID-19 increased the risk of DVT aggravation among patients who completed three months anticoagulant therapy (HR: 5.667, P=0.0001), but did not increase incidence rate among patients who completed more than three months anticoagulant therapy (HR:1.198, P=0.683).
  • #12 The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03036-3
    Our study reveals an increased risk of DVT aggravation following COVID-19 during anticoagulation treatment, particularly among patients with distal DVT or those who have completed only three months anticoagulant therapy. […] Adverse effects of COVID-19 on DVT prognosis were observed across various benign and malignant respiratory diseases. […] Additionally, extended-term anticoagulant therapy was identified as an effective approach to enhance DVT control among patients with COVID-19.
  • #13 A lung cancer patient with deep vein thrombosis:a case report and literature review | BMC Cancer | Full Text
    https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-5513-8
    Venous thromboembolism (VTE) is a common problem in cancer patients and the incidence is increasing, especially for patients with lung cancer. […] Its rare that the conditions of cancer patients who develop venous thromboembolism (VTE) keep deteriorating despite the administration of aspirin, warfarin and low weight molecular heparin. Both early diagnosis and prophylactic use of anticoagulants are suggested for cancer patients to improve the prognosis. […] DVT is a well-studied cancer complication and the incidence is estimated to be from 4 to 17% in patients presenting underlying malignancies. […] When compared to cancer patients without thrombosis, patients with both thrombotic events and cancer have a lower survival rate. […] Its recommended that the risk of VTE should be assessed before the commencement of chemotherapy. […] Advanced stage is confirmed to be a strong predictor of VTE in patients with non-small cell lung carcinoma (NSCLC). […] A prophylactic use of anticoagulants is recommended for patients with advanced lung cancer.
  • #14 A lung cancer patient with deep vein thrombosis:a case report and literature review | BMC Cancer | Full Text
    https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-5513-8
    Venous thromboembolism (VTE) is a common problem in cancer patients and the incidence is increasing, especially for patients with lung cancer. […] Its rare that the conditions of cancer patients who develop venous thromboembolism (VTE) keep deteriorating despite the administration of aspirin, warfarin and low weight molecular heparin. Both early diagnosis and prophylactic use of anticoagulants are suggested for cancer patients to improve the prognosis. […] DVT is a well-studied cancer complication and the incidence is estimated to be from 4 to 17% in patients presenting underlying malignancies. […] When compared to cancer patients without thrombosis, patients with both thrombotic events and cancer have a lower survival rate. […] Its recommended that the risk of VTE should be assessed before the commencement of chemotherapy. […] Advanced stage is confirmed to be a strong predictor of VTE in patients with non-small cell lung carcinoma (NSCLC). […] A prophylactic use of anticoagulants is recommended for patients with advanced lung cancer.
  • #15
    https://journals.lww.com/md-journal/fulltext/2024/01050/machine_learning_based_model_for_prediction_of.36.aspx
    Successful monitoring of deep vein thrombosis (DVT) remains a challenging problem after gynecological laparoscopy. […] We found postoperative DVT in 41 (8.38%) patients. […] In summary, we explored the potential risk of DVT after gynecological laparoscopy, which helps clinicians identify high-risk patients before gynecological laparoscopy and make nursing interventions. […] The RFM algorithm can achieve the optimal DVT prediction performance, with AUC values of 0.851 (95% CI: 0.7930.909) and 0.862 (95% CI: 0.8040.920) in the training and validation sets, respectively. […] The ROC curve in this study showed that the RFM model had higher predictive power than the ANNM model in both training and validation sets, with area under the curve (AUCs) of 0.851 and 0.862, and 95% confidence intervals (CI) of 0.7930.909 and 0.8040.920, respectively.
  • #16
    https://journals.lww.com/md-journal/fulltext/2024/01050/machine_learning_based_model_for_prediction_of.36.aspx
    The prognostic implications of DVT prediction model might facilitate more responsive health systems that are conducive to patients with high-risk DVT via early identification, and ensuing instant intervention as well as intensive care and monitoring, thus, hopefully assisting to optimize nursing intervention strategies after laparoscopy. […] In summary, our combination of advanced ML algorithms and clinical features can timely and accurately classify high-risk DVT patients, especially the DVT prediction model based on RFM, which can help clinical healthcare professionals identify DVT in a timely manner and provide appropriate clinical care to promote postoperative recovery and improve patient prognosis.
  • #17 Non-invasive diagnosis of deep vein thrombosis from ultrasound imaging with machine learning | npj Digital Medicine
    https://www.nature.com/articles/s41746-021-00503-7
    Deep vein thrombosis (DVT) is a blood clot most commonly found in the leg, which can lead to fatal pulmonary embolism (PE). […] DVT has a high level of morbidity. 30-50% of the surviving patients develop long-term symptoms in their affected leg (post-thrombotic syndrome). […] Rapid diagnosis is known to improve compliance to regulatory guidelines that state DVT should be diagnosed within 24h. […] Our method suggests a diagnosis based on robust segmentation in contrast to a direct image discriminator model. […] Our model learns predominantly from healthy volunteer data how a healthy vessel looks like and uses this knowledge to identify DVT suspected patients in the test data. […] A positive test with AutoDVT will always lead to a confirmatory scan with an expert, who will also make treatment decisions which may include secondary criteria like for example the age of the thrombus.
  • #18 Non-invasive diagnosis of deep vein thrombosis from ultrasound imaging with machine learning | npj Digital Medicine
    https://www.nature.com/articles/s41746-021-00503-7
    Our study shows the potential of a ML-powered system using free-hand ultrasound to identify DVT in clinical populations with high-throughput requirements and at the primary care level. […] A DVT examination software tool could cost up to 72-175 at the sensitivity and specificity levels measured in Table 5, before the NMB falls below 0. […] The NMB has been simulated with a deterministic model for each of the diagnostic algorithm variants in Fig. 11 at the mean (solid line) and the 95 CI interval (shaded area) from Table 5 to show possible optimistic and pessimistic scenarios. […] Our study has several limitations. […] The ultimate goal of employing AI support for DVT diagnosis would be to develop a ML-powered system using free-hand ultrasound that enables healthcare generalists at the point of care to exclude the presence of DVT in negative cases. […] The implications of this are particularly significant in the context of a false negative outcome given the possibility of DVT progression to PE and even death. […] The study we describe confirms that the AutoDVT software can diagnose DVT accurately.
  • #19 Real-life impact of clinical prediction rules for venous thromboembolism in primary care: a cross-sectional cohort study | BMJ Open
    https://bmjopen.bmj.com/content/10/12/e039913
    Correct application of CPRs for VTE in primary care is associated with a high efficiency and an acceptable low failure rate. Importantly, in nearly a quarter of patients, the CPRs were incorrectly applied that resulted in a lower efficiency and a higher failure rate. Such incorrect application of CPRs was more common in the presence of concurrent heart failure. […] The overall failure rate of both CPRs combined in the total study population was 1.8% (95% CI 1.02 to 3.06) and the overall efficiency was 53% (95% CI 50.4 to 55.5). The failure rate and efficiency split up for correct and incorrect use of the CPRs in the total study population, suspected DVT and PE group are shown in figure 1. In the total study population the failure rate increased from 1.51% (95% CI 0.77 to 2.86) when the CPR was correctly used to 3.31% (95% CI 1.07 to 8.76) when the CPR was incorrectly used and the efficiency decreased from 58.1% (95% CI 55.2 to 61.0) to 35.7% (95% CI 30.6 to 41.1).
  • #20 Real-life impact of clinical prediction rules for venous thromboembolism in primary care: a cross-sectional cohort study | BMJ Open
    https://bmjopen.bmj.com/content/10/12/e039913
    Correct application of CPRs for VTE in primary care is associated with a high efficiency and an acceptable low failure rate. Importantly, in nearly a quarter of patients, the CPRs were incorrectly applied that resulted in a lower efficiency and a higher failure rate. Such incorrect application of CPRs was more common in the presence of concurrent heart failure. […] The overall failure rate of both CPRs combined in the total study population was 1.8% (95% CI 1.02 to 3.06) and the overall efficiency was 53% (95% CI 50.4 to 55.5). The failure rate and efficiency split up for correct and incorrect use of the CPRs in the total study population, suspected DVT and PE group are shown in figure 1. In the total study population the failure rate increased from 1.51% (95% CI 0.77 to 2.86) when the CPR was correctly used to 3.31% (95% CI 1.07 to 8.76) when the CPR was incorrectly used and the efficiency decreased from 58.1% (95% CI 55.2 to 61.0) to 35.7% (95% CI 30.6 to 41.1).
  • #21 Deep Vein Thrombosis (DVT)
    https://my.clevelandclinic.org/health/diseases/16911-deep-vein-thrombosis-dvt
    A DVT can take several months to a year to come apart, so you’ll need to keep taking blood thinner medicines as instructed and keep wearing compression stockings until your provider tells you to stop. […] You may need blood tests to make sure you’re getting the right dose of blood thinners. […] Your provider may want to do more ultrasounds later to find out if your blood clot is still in the same place, improving or getting larger.
  • #22 Deep Vein Thrombosis (DVT)
    https://my.clevelandclinic.org/health/diseases/16911-deep-vein-thrombosis-dvt
    A DVT can take several months to a year to come apart, so you’ll need to keep taking blood thinner medicines as instructed and keep wearing compression stockings until your provider tells you to stop. […] You may need blood tests to make sure you’re getting the right dose of blood thinners. […] Your provider may want to do more ultrasounds later to find out if your blood clot is still in the same place, improving or getting larger.
  • #23 Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/1911303-overview
    Most cases of deep venous thrombosis (DVT) are occult and usually resolve spontaneously without complication. […] The principal long-term morbidity from DVT is postthrombotic syndrome, which complicates about a quarter of cases of symptomatic proximal DVT; most cases develop within 2 years afterward. […] The development of postthrombotic syndrome and chronic insufficiency may cause significant negative effects on quality of life comparable to chronic diseases, such as diabetes, obstructive lung disease, and heart failure. […] Pulmonary embolism (PE) is the leading cause of preventable in-hospital mortality. […] Death from DVT is attributed to massive PE, which causes as many as 100,000 deaths annually in the United States.
  • #24 The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03036-3
    Coronavirus disease 2019 (COVID-19) has been proved as a significant risk factor for deep vein thrombosis (DVT) after several waves of pandemic. This study aims to further investigate impact of COVID-19 on prognosis of DVT following anticoagulation treatment. […] In 2022, patients exhibited higher incidence rates of DVT aggravation compared to those in 2021 (HR:2.311, P=0.0018). […] In PSM-matched cohorts, the risk for DVT aggravation was 3.182 times higher in COVID-19 group compared to the control group (P=0.0001). […] Exposure to COVID-19 increased the risk of DVT aggravation among patients who completed three months anticoagulant therapy (HR: 5.667, P=0.0001), but did not increase incidence rate among patients who completed more than three months anticoagulant therapy (HR:1.198, P=0.683).
  • #25 The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03036-3
    Our study reveals an increased risk of DVT aggravation following COVID-19 during anticoagulation treatment, particularly among patients with distal DVT or those who have completed only three months anticoagulant therapy. […] Adverse effects of COVID-19 on DVT prognosis were observed across various benign and malignant respiratory diseases. […] Additionally, extended-term anticoagulant therapy was identified as an effective approach to enhance DVT control among patients with COVID-19.
  • #26 A lung cancer patient with deep vein thrombosis:a case report and literature review | BMC Cancer | Full Text
    https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-5513-8
    Venous thromboembolism (VTE) is a common problem in cancer patients and the incidence is increasing, especially for patients with lung cancer. […] Its rare that the conditions of cancer patients who develop venous thromboembolism (VTE) keep deteriorating despite the administration of aspirin, warfarin and low weight molecular heparin. Both early diagnosis and prophylactic use of anticoagulants are suggested for cancer patients to improve the prognosis. […] DVT is a well-studied cancer complication and the incidence is estimated to be from 4 to 17% in patients presenting underlying malignancies. […] When compared to cancer patients without thrombosis, patients with both thrombotic events and cancer have a lower survival rate. […] Its recommended that the risk of VTE should be assessed before the commencement of chemotherapy. […] Advanced stage is confirmed to be a strong predictor of VTE in patients with non-small cell lung carcinoma (NSCLC). […] A prophylactic use of anticoagulants is recommended for patients with advanced lung cancer.
  • #27 Prognosis and Factors 4 to 10 Years After Deep Vein Thrombosis: A Long-Term Follow-up Cohort Study
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11375659/
    Post-thrombotic syndrome (PTS) is one of the most common long-term complications of lower extremity deep vein thrombosis (DVT). In our study, 54.1% of patients with DVT (271 of 501) experienced indications and manifestations of PTS. By statistical analysis, we found that the outcome of thrombosis was the influencing factor of PTS score (1-4 points, P.05). The grading of PTS was primarily influenced by the history of varicose veins and DVT in the lower extremities. The duration of taking antithrombotic drugs affected the outcome of thrombosis (P.05), especially among the female patients. The study found that the severity of thrombosis significantly influenced the PTS score (1-4 points), that is, PTS score 1, 2, 3, and 4 points were all affected by the outcome of thrombosis and the difference was statistically significant (P.05). The results of this study suggest that the history of varicose veins and DVT involvement in both lower limbs are important factors affecting PTS grading.
  • #28 The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03036-3
    Coronavirus disease 2019 (COVID-19) has been proved as a significant risk factor for deep vein thrombosis (DVT) after several waves of pandemic. This study aims to further investigate impact of COVID-19 on prognosis of DVT following anticoagulation treatment. […] In 2022, patients exhibited higher incidence rates of DVT aggravation compared to those in 2021 (HR:2.311, P=0.0018). […] In PSM-matched cohorts, the risk for DVT aggravation was 3.182 times higher in COVID-19 group compared to the control group (P=0.0001). […] Exposure to COVID-19 increased the risk of DVT aggravation among patients who completed three months anticoagulant therapy (HR: 5.667, P=0.0001), but did not increase incidence rate among patients who completed more than three months anticoagulant therapy (HR:1.198, P=0.683).
  • #29 The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03036-3
    Our study reveals an increased risk of DVT aggravation following COVID-19 during anticoagulation treatment, particularly among patients with distal DVT or those who have completed only three months anticoagulant therapy. […] Adverse effects of COVID-19 on DVT prognosis were observed across various benign and malignant respiratory diseases. […] Additionally, extended-term anticoagulant therapy was identified as an effective approach to enhance DVT control among patients with COVID-19.
  • #30 The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03036-3
    Coronavirus disease 2019 (COVID-19) has been proved as a significant risk factor for deep vein thrombosis (DVT) after several waves of pandemic. This study aims to further investigate impact of COVID-19 on prognosis of DVT following anticoagulation treatment. […] In 2022, patients exhibited higher incidence rates of DVT aggravation compared to those in 2021 (HR:2.311, P=0.0018). […] In PSM-matched cohorts, the risk for DVT aggravation was 3.182 times higher in COVID-19 group compared to the control group (P=0.0001). […] Exposure to COVID-19 increased the risk of DVT aggravation among patients who completed three months anticoagulant therapy (HR: 5.667, P=0.0001), but did not increase incidence rate among patients who completed more than three months anticoagulant therapy (HR:1.198, P=0.683).
  • #31 The impact of COVID-19 on the prognosis of deep vein thrombosis following anticoagulation treatment: a two-year single-center retrospective cohort study | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03036-3
    Our study reveals an increased risk of DVT aggravation following COVID-19 during anticoagulation treatment, particularly among patients with distal DVT or those who have completed only three months anticoagulant therapy. […] Adverse effects of COVID-19 on DVT prognosis were observed across various benign and malignant respiratory diseases. […] Additionally, extended-term anticoagulant therapy was identified as an effective approach to enhance DVT control among patients with COVID-19.
  • #32 A lung cancer patient with deep vein thrombosis:a case report and literature review | BMC Cancer | Full Text
    https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-5513-8
    Venous thromboembolism (VTE) is a common problem in cancer patients and the incidence is increasing, especially for patients with lung cancer. […] Its rare that the conditions of cancer patients who develop venous thromboembolism (VTE) keep deteriorating despite the administration of aspirin, warfarin and low weight molecular heparin. Both early diagnosis and prophylactic use of anticoagulants are suggested for cancer patients to improve the prognosis. […] DVT is a well-studied cancer complication and the incidence is estimated to be from 4 to 17% in patients presenting underlying malignancies. […] When compared to cancer patients without thrombosis, patients with both thrombotic events and cancer have a lower survival rate. […] Its recommended that the risk of VTE should be assessed before the commencement of chemotherapy. […] Advanced stage is confirmed to be a strong predictor of VTE in patients with non-small cell lung carcinoma (NSCLC). […] A prophylactic use of anticoagulants is recommended for patients with advanced lung cancer.
  • #33 Predictive factors of clot propagation in patients with superficial venous thrombosis towards deep venous thrombosis and pulmonary embolism: a systematic review and meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/14/4/e074818
    Although the pooled estimates of the predictors high age, male sex, history of VTE, cancer and absence of varicose veins showed predictive potential in isolation, variability in study designs, lack of multivariable adjustment and high risk of bias prevent firm conclusions. […] The most reported predictive factors for DVT and/or PE progression in patients with SVT were high age, male sex, history of VTE, cancer and absence of varicose veins. […] This review contributes to the clinical knowledge on the natural prognosis of SVT, a prevalent but still understudied thrombotic condition. […] Predictors that might be useful in this setting include high age, male sex, history of VTE, cancer and absence of varicose veins, that all appear to increase the risk of clot propagation or progression to DVT or PE.
  • #34 Predictive factors of clot propagation in patients with superficial venous thrombosis towards deep venous thrombosis and pulmonary embolism: a systematic review and meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/14/4/e074818
    This is a systematic summary of 22 papers describing prognostic and cross-sectional clinical predictors in patients with SVT of clot propagation towards DVT and/or PE up to 3 March 2023. The most reported clinical predictors were high age, male sex, history of VTE, cancer and absence of varicose veins and these predictors show potential for further multivariable exploration.
  • #35 Real-life impact of clinical prediction rules for venous thromboembolism in primary care: a cross-sectional cohort study | BMJ Open
    https://bmjopen.bmj.com/content/10/12/e039913
    Correct application of CPRs for VTE in primary care is associated with a high efficiency and an acceptable low failure rate. Importantly, in nearly a quarter of patients, the CPRs were incorrectly applied that resulted in a lower efficiency and a higher failure rate. Such incorrect application of CPRs was more common in the presence of concurrent heart failure. […] The overall failure rate of both CPRs combined in the total study population was 1.8% (95% CI 1.02 to 3.06) and the overall efficiency was 53% (95% CI 50.4 to 55.5). The failure rate and efficiency split up for correct and incorrect use of the CPRs in the total study population, suspected DVT and PE group are shown in figure 1. In the total study population the failure rate increased from 1.51% (95% CI 0.77 to 2.86) when the CPR was correctly used to 3.31% (95% CI 1.07 to 8.76) when the CPR was incorrectly used and the efficiency decreased from 58.1% (95% CI 55.2 to 61.0) to 35.7% (95% CI 30.6 to 41.1).

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pończochy uciskowe zespół pozakrzepowy reguła predykcji klinicznej badanie ultrasonograficzne zakrzepica żył głębokich niedrobnokomórkowy rak płuca podstawowa opieka zdrowotna terapia przeciwzakrzepowa chemioterapia zatorowość płucna cukrzyca model Random Forest lek przeciwzakrzepowy przewlekła obturacyjna choroba płuc niewydolność serca żylna choroba zakrzepowo-zatorowa obraz USG antykoagulant przewlekła niewydolność żylna żylaki