Do Patients with Acute Deep Vein Thrombosis Have Fever?

Abstract

The purpose of this study was to determine whether those with lower extremity acute venous thrombosis have fever. During a recent 14.5-month period, 1847 patients undergoing lower extremity venous duplex scanning also had their oral temperature measured using a digital thermometer at the time of duplex examination. Patients were 57.8 ± 17.3 years of age (range, 14 to 99). Temperature was 98.5 ± 1.1° F. Twenty-three patients had acute inferior vena cava thrombosis, 60 had acute iliac vein thrombosis, 138 had acute femoral venous thrombosis, and 131 had acute popliteal venous thrombosis. Calf vein thromboses were present in 102 patients, and 43 patients had superficial venous thrombosis. A total of 228 patients had acute lower extremity venous thrombosis in one or more of these venous segments. Temperature with acute lower extremity venous thrombosis was 98.7 ± 1.05° F versus 98.5 ± 1.10° F in those with no acute thrombosis. Although small, this temperature difference was statistically significant ( P < 0.02). Acute deep venous thrombosis (DVT) was defined as acute popliteal or more proximal femoral, iliac, or vena cava thrombosis. The temperature for the 175 patients with acute DVT was 98.7 ± 1.10° F versus 98.5 ± 1.10° F for those without DVT ( P < 0.035). There was no temperature that served to accurately differentiate those who did from those who did not have DVT. The frequency that patients with DVT had fever, defined as a temperature ≥100° F, was 9.1 per cent (16 of 175) with DVT versus 7.5 per cent (126 of 1678) without DVT (not significant). In the subgroup with a temperature ≥101° F, 4.6 per cent (8 of 175) with DVT had such a fever versus 3.4 per cent (57 of 1672) without DVT (not significant). Those undergoing venous duplex who were found to have acute lower extremity venous thrombosis, including acute DVT, had statistically higher temperatures, but such temperature differences were minimal. The incidence of fever, defined as a temperature ≥100° F or ≥101° F, was not different between those with and those without acute DVT. It appears that the presence of fever may not be a sensitive or specific indicator for the presence of underlying acute DVT.

Senior Capstone Papers from Students in the Vascular Ultrasound Program at Seattle University

“…Although the study by Kazmers et al did not demonstrate that fever is a strong indicator of DVT, the more recent study by Barba et al showed worse outcomes for patients experiencing both fever and DVT and provides a sufficient reason to diagnose DVT in a febrile patient as soon as possible so that appropriate treatment can be started. 2,12 This combined research demonstrates that the presence of fever alone can be an indication of existing DVT and warrants an ultrasound examination. While the wish to preserve a sonographer's time to perform this examination when it is truly needed, the data collected show that there is a correlation between DVT and FUO and that, when coexisting, they pose a dangerous threat to the patient's wellbeing.…”

“…The objective of the study by AbuRahma et al was to see whether the presence of DVT could explain a patient's FUO, whereas Kazmers et al sought to document how many times DVT and fever coexisted to provide more clarity on the clinical correlation, if any. 10,12 A more recent study published by Barba et al 2 in 2011 states that the presence of fever can be a warning sign of acute DVT. This study is different than the 2 previously discussed studies because its objective is not to provide data supporting a connection between the 2 variables.…”

“…11 They gathered 89 patient duplex examinations over a 2-year period with an average age of 58 years. 10 A study published 3 years later in June 2000 by Kazmers et al 12 compared oral temperatures of patients with known DVT over a period of 14.5 months. While AbuRahma et al looked for DVT in the presence of FUO, this study looked for presence of fever in the setting of already diagnosed DVT.…”

“…Kazmers et al 12 monitored the temperatures of patients undergoing venous duplex examinations in their lower extremities, recording those who were found to have both acute DVT and a fever. They only diagnosed acute DVT if it was found in the popliteal region or more proximal in the femoral vein, iliac vein, or vena cava, choosing not to include any data about DVT found in deep veins in the calf.…”

“…Forty percent of DVT is found in the distal veins of the calf, and while DVT is more concerning when it involves the more proximal larger veins, there is still a chance that the clot could break off and propagate proximally. 12 Barba et al 2 stated that fever is a presenting sign of DVT and that a correlation between the 2 variables does exist. They centered their study around whether patients who had fever accompanying their DVT had worse outcomes than patients with DVT who remained afebrile.…”