Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function

Mazzolai, Lucia; Aboyans, Victor; Ageno, Walter; Agnelli, Giancarlo; Alatri, Adriano; Bauersachs, Rupert; Brekelmans, Marjolein P. A.; Büller, Harry R.; Elias, Antoine; Farge, Dominique; Konstantinides, Stavros; Palareti, Gualtiero; Prandoni, Paolo; Righini, Marc; Torbicki, Adam; Vlachopoulos, Charalambos; Brodmann, Marianne

doi:10.1093/eurheartj/ehx003

Cited by 290 publications

(296 citation statements)

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“…Moheimani and Jackson referred in their study to the age above 40 years as a risk factor for DVT incidence [11]. Furthermore, previous studies have shown that the incidence rate of VTE increases with age [10]. The results of Khavaninzadeh et al's study showed that there is a significant relationship between the age and the need for anti-DVT prophylaxis in such way that prophylaxis rate increases with the age [18].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, studies recommend the use of the enzyme-linked immunosorbent assay (ELISA) method, a rapid quantitative ELISA, and turbidimetric D-dimer testing (advanced D-dimer) for the diagnosis of VTE, which have a sensitivity of more than 95% [9]. Mazzolai et al showed that a negative ELISA and D-dimer testing can eliminate DVT without further testing in 30% of patients with thromboembolic risk <1% within 3 months after treatment [10].…”

Section: Discussionmentioning

confidence: 99%

“…Experts suggest using modified Wells two-level pre-test for its simplicity [10]. Previous studies have reported that most health professionals perform DVT risk assessment based on their experience, which is not suitable for clinical evaluation of patients [12].…”

Section: Moghadam Et Almentioning

confidence: 99%

“…Now, considering the lack of continuous access to the physician, on the one hand, and the continuous presence of nurses on the patients' bedside on the other hand, nursing care interventions play an important in preventing the development of embolism and its timely diagnosis [15]. Considering the importance of the role and position of nursing in evaluating the risk of VTE [8], as well as the use of Wells modified two-level pre-test for patients recommended by experts [10], the present aimed to determine the effect of nursing interventions on incidence of DVT in ICU patients based on the Wells modified score.…”

Section: Moghadam Et Almentioning

confidence: 99%

“…DVT Wells score has been widely studied and recommended as a first step in the diagnostic algorithm to pre-test the risk assessment in suspected DVT patients [9]. It can also be used for outpatients or inpatients [10]. Based on Wells clinical prediction rule (1997), patients were divided into low-, moderate-, and high-risk groups with DVT prevalence rate of 5%, 17%, and 53%, respectively [9].…”

mentioning

confidence: 99%

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Investigating Effect of Nursing Interventions, Based on Wells Score Results, on the Incidence of Deep Vein Thrombosis in Patients Admitted to the Intensive Care Unit

Moghadam

Asadizaker

Jahani

et al. 2018

Asian J Pharm Clin Res

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Objective: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complaint in critically ill patients. Therefore, the present study was conducted to determine the effect of nursing interventions, based on the Wells results, on the incidence of DVT in intensive care unit (ICU) patients.Methods: The present clinical trial was conducted on 72 ICU patients without DVT and PE who met the inclusion criteria according to Wells score in Dr. Ganjavian Hospital, Dezful in 2012. The participants were investigated and randomly divided into intervention (n=36) and control groups (n=36). The intervention group received preventive nursing measures based on the risk level determined by the Wells score, and routine therapeutic interventions were performed for the control group. Then, patients were evaluated using Wells score, D-dimer testing, and Doppler sonography on the 1st, 5th, and 10th days. Data were finally coded and entered into SPSS version 23. Data analysis was performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.Results: The incidence of DVT in both groups showed that 2 patients of the control group who were identified to be at risk using the Wells score were diagnosed with DVT while none of the patients of the intervention group experienced DVT. The present study showed that 22.2% of the patients of the control group suffered from non-pitting edema, which was significantly different from the intervention group (p=0.005).Conclusion: The results of the present study showed that using the Wells score for early identification of the at-risk patients and nursing interventions based on this score’s results is helpful in the prevention of DVT. Appropriate nursing interventions were also effective in reducing the incidence of non-pitting edema in the lower extremities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Moghadam Et Almentioning

confidence: 99%

Section: Moghadam Et Almentioning

confidence: 99%

mentioning

confidence: 99%

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Investigating Effect of Nursing Interventions, Based on Wells Score Results, on the Incidence of Deep Vein Thrombosis in Patients Admitted to the Intensive Care Unit

Moghadam

Asadizaker

Jahani

et al. 2018

Asian J Pharm Clin Res

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Venous Thromboembolism

Tritschler

Kraaijpoel

Gal

et al. 2018

JAMA

236

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enous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease. The estimated incidence of a first acute VTE is 0.7 to 1.4 per 1000 person-years and is mostly observed in patients older than 55 years. [1][2][3][4] While the incidence of DVT has remained constant over time, 5 hospital admissions for PE in the United States more than doubled over the last decades, 6 partly because of widespread use of sensitive imaging techniques detecting smaller, potentially insignificant emboli. 7 Even though the in-hospital case-fatality rate of PE has decreased in the United States between 1999 and 2008, 8 about 30% of patients with PE die within the first year after diagnosis. 4 The socioeconomic effect of VTE is significant, with estimated annual costs ranging from $13.5 billion to $27.2 billion in the United States. 9Clinical signs and symptoms of DVT include unilateral leg pain, redness, swelling, edema, warmth, and tenderness. Pulmonary embolism may present with dyspnea, chest pain, hemoptysis, syncope, tachycardia, and hypotension. The clinical presentation of VTE is often not specific, and DVT can be indistinguishable from cellulitis, hematoma, superficial thrombophlebitis, and congestive heart failure. Pulmonary embolism presents similarly to myocardial infarction, congestive heart failure, and other diseases. Consequently, imaging is needed to confirm the diagnosis of VTE. The diagnosis of VTE is made in a sequence of steps including assessment of the pretest probability, followed by D-dimer testing and imaging as appropriate (Figure 1). When VTE is diagnosed, immediate initiation of anticoagulant therapy is imperative. The choice among different anticoagulant agents and the duration of treatment are based IMPORTANCE Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease.OBJECTIVE To summarize the advances in diagnosis and treatment of VTE of the past 5 years.EVIDENCE REVIEW A systematic search was conducted in EMBASE Classic, EMBASE, Ovid MEDLINE, and other nonindexed citations using broad terms for diagnosis and treatment of VTE to find systematic reviews and meta-analyses, randomized trials, and prospective cohort studies published between January 1, 2013, and July 31, 2018. The 10th edition of the American College of Chest Physicians Antithrombotic Therapy Guidelines was screened to identify additional studies. Screening of titles, abstracts, and, subsequently, full-text articles was performed in duplicate, as well as data extraction and risk-of-bias assessment of the included articles.FINDINGS Thirty-two articles were included in this review. The application of an age-adjusted D-dimer threshold in patients with suspected PE has increased the number of patients in whom imaging can be withheld. The Pulmonary Embolism Rule-Out Criteria safely exclude PE when the pretest probability is low. The introduction of direct oral anticoagulants has allowed for a simpli...

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Diagnosis and Treatment of Lower Extremity Venous Thromboembolism

Chopard

Albertsen

Piazza

2020

JAMA

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ower extremity venous thromboembolism (VTE), including deep vein thrombosis (DVT) of the leg, is common. 1 The incidence rate for DVT ranges from 88 to 112 per 100 000 person-years. 2 Rates of recurrent VTE range from 20% to 36% during the 10 years after an initial event. 3,4 Isolated distal DVT, defined as thrombosis involving 1 or more of the deep calf veins without reaching the popliteal vein, is associated with a 1-year all-cause mortality rate of 4.6 per 100 person-years (95% CI, 3.8-5.7). 5 This review provides an evidence-based update of the diagnosis and therapy of lower extremity DVT. MethodsWe searched PubMed and the Cochrane databases for Englishlanguage studies published from January 2015 through June 2020 for randomized clinical trials, meta-analyses, systematic reviews, and observational studies, resulting in 2125 retrieved articles (see eAppendix in the Supplement for search terms). We manually searched references of selected articles, reviews, meta-analyses, and practice guidelines. Selected articles were mutually agreed on by the authors. A total of 86 articles (20 randomized clinical trials, 20 systematic reviews and meta-analyses, 33 observational cohort studies, 7 reviews, and 6 guideline documents) were included in the final review. Randomized clinical trials and meta-analyses and information of interest to a general medical readership were prioritized. Risk Factors for VTEMost patients with VTE have multiple risk factors for VTE (Table 1). Risk factors include demographic factors (eg, older age, IMPORTANCE Incidence rates for lower extremity deep vein thrombosis (DVT) range from 88 to 112 per 100 000 person-years and increase with age. Rates of recurrent VTE range from 20% to 36% during the 10 years after an initial event.OBSERVATIONS PubMed and Cochrane databases were searched for English-language studies published from January 2015 through June 2020 for randomized clinical trials, meta-analyses, systematic reviews, and observational studies. Risk factors for venous thromboembolism (VTE), such as older age, malignancy (cumulative incidence of 7.4% after a median of 19 months), inflammatory disorders (VTE risk is 4.7% in patients with rheumatoid arthritis and 2.5% in those without), and inherited thrombophilia (factor V Leiden carriers with a 10-year cumulative incidence of 10.9%), are associated with higher risk of VTE. Patients with signs or symptoms of lower extremity DVT, such as swelling (71%) or a cramping or pulling discomfort in the thigh or calf (53%), should undergo assessment of pretest probability followed by D-dimer testing and imaging with venous ultrasonography. A normal D-dimer level (ie, D-dimer <500 ng/mL) excludes acute VTE when combined with a low pretest probability (ie, Wells DVT score Յ1). In patients with a high pretest probability, the negative predictive value of a D-dimer less than 500 ng/mL is 92%. Consequently, D-dimer cannot be used to exclude DVT without an assessment of pretest probability. Postthrombotic syndrome, defined as persistent symptoms, signs of ch...

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Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function

Cited by 290 publications

References 126 publications

Investigating Effect of Nursing Interventions, Based on Wells Score Results, on the Incidence of Deep Vein Thrombosis in Patients Admitted to the Intensive Care Unit

Investigating Effect of Nursing Interventions, Based on Wells Score Results, on the Incidence of Deep Vein Thrombosis in Patients Admitted to the Intensive Care Unit

Venous Thromboembolism

Diagnosis and Treatment of Lower Extremity Venous Thromboembolism

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