Isolated distal deep vein thrombosis: what we know and what we are doing

Palareti, Gualtiero; Schellong, Sebastian

doi:10.1111/j.1538-7836.2011.04564.x

Cited by 118 publications

(121 citation statements)

References 58 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…11 In patients examined for suspected PE or leg DVT, the prevalence of IDDVT ranged between 7% to 11% in cases with suspected PE and 4% to 15% in suspected DVT, while it ranged between 23% and 59% in patients who had received a diagnosis of DVT. 12 This large variation in the prevalence of IDDVT in patients with DVT may be, at least partially, attributed to the different patient populations investigated, as well as to the different diagnostic strategies and examination protocols adopted. If all patients with suspected DVT are examined with a complete CUS procedure, IDDVTs should account for about half of all DVTs diagnosed.…”

Section: 10mentioning

confidence: 99%

How I treat isolated distal deep vein thrombosis (IDDVT)

Palareti

2014

Blood

105

View full text Add to dashboard Cite

Thromboses limited to infrapopliteal leg deep veins (isolated distal deep vein thrombosis [IDDVT]) are frequently diagnosed in subjects with suspected pulmonary embolism or DVT and account for one-fourth to one-half of all diagnosed leg DVTs. Despite their frequency, the natural history of IDDVTs and their real risk of thromboembolic complications are still uncertain because of the scarcity of prospective, blind, nonintervention studies. Therefore it is still debated whether they warrant diagnosis and treatment. Diagnosis is based on ultrasonographic examination, which is more operator dependent and less sensitive in distal than in proximal veins. The available data seem to support the view that most IDDVTs are self-limiting and inconsequential for patients, though in some cases they can be associated with complications and warrant diagnosis and treatment. The available guidelines for treatment of IDDVTs give different indications ranging from serial imaging of the deep veins for 2 weeks to detect and treat only in case of proximal extension, to giving oral anticoagulation in all IDDVT patients for 3 months. I review this issue, focusing on possible and suggested treatments in symptomatic IDDVT patients, and describe our current therapeutic approach to these patients.

show abstract

Section: 10mentioning

confidence: 99%

How I treat isolated distal deep vein thrombosis (IDDVT)

Palareti

2014

Blood

105

View full text Add to dashboard Cite

show abstract

“…29 Even in the hematology literature, there is controversy over the management of lower-extremity DVTs, especially those that arise in infrapopliteal veins. 39,40 The ACS-NSQIP dataset does not provide information regarding the location of DVT events documented.…”

mentioning

confidence: 99%

Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy

Kimmell

Jahromi

2015

JNS

View full text Add to dashboard Cite

The most recent meta-analysis of VTE prophylaxis in neurosurgical patients concluded abbreviatioNs ACS = American College of Surgeons; ASA = American Society of Anesthesiologists; BMI = body mass index; CI = confidence interval; CPT = current procedural terminology; DVT = deep venous thrombosis; MI = myocardial infarction; NSQIP = National Surgical Quality Improvement Program; OR = odds ratio; PE = pulmonary embolism; RCT = randomized controlled trial; SCIP = Surgical Care Improvement Project; TIA = transient ischemic attack; UTI = urinary tract infection; VTE = venous thromboembolism. submitted March 31, 2014. accepted October 22, 2014. iNclude wheN citiNg Published online December 12, 2014; DOI: 10.3171/2014.10.JNS14632. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomyKristopher t. Kimmell, md, and babak s. Jahromi, md, phd Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York obJect Patients undergoing craniotomy are at risk for developing venous thromboembolism (VTE). The safety of anticoagulation in these patients is not clear. The authors sought to identify risk factors predictive of VTE in patients undergoing craniotomy. methods The authors reviewed a national surgical quality database, the American College of Surgeons National Surgical Quality Improvement Program. Craniotomy patients were identified by current procedural terminology code. Clinical factors were analyzed to identify associations with VTE. results Four thousand eight hundred forty-four adult patients who underwent craniotomy were identified. The rate of VTE in the cohort was 3.5%, including pulmonary embolism in 1.4% and deep venous thrombosis in 2.6%. A number of factors were found to be statistically significant in multivariate binary logistic regression analysis, including craniotomy for tumor, transfer from acute care hospital, age ≥ 60 years, dependent functional status, tumor involving the CNS, sepsis, emergency surgery, surgery time ≥ 4 hours, postoperative urinary tract infection, postoperative pneumonia, on ventilator ≥ 48 hours postoperatively, and return to the operating room. Patients were assigned a score based on how many of these factors they had (minimum score 0, maximum score 12). Increasing score was predictive of increased VTE incidence, as well as risk of mortality, and time from surgery to discharge. coNclusioNs Patients undergoing craniotomy are at low risk of developing VTE, but this risk is increased by preoperative medical comorbidities and postoperative complications. The presence of more of these clinical factors is associated with progressively increased VTE risk; patients possessing a VTE Risk Score of ≥ 5 had a greater than 20-fold increased risk of VTE compared with patients with a VTE score of 0.

show abstract

“…However, there remains debate over the management of distal calf thrombi and the value in treating distal DVT events [13,14]. While this treatment debate continues, the sequelae to DVT's are potentially serious and have marked impact on mor bidity [15,16]. These sequelae can range in severity from ve nous insufficiency, oedema and ulceration to pulmo nary embolism and death [15,17].…”

Section: Discussionmentioning

confidence: 99%