Systematic review and meta-analysis of outcomes in patients with suspected deep vein thrombosis

Abstract

After deep vein thrombosis (DVT) is diagnosed, prompt evaluation and therapeutic intervention are of paramount importance for improvement in patient-important outcomes. We systematically reviewed patient-important outcomes in patients with suspected DVT, including mortality, incidence of pulmonary embolism (PE) and DVT, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, Ovid Medline, Embase for eligible studies, references lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Nine studies with 5126 patients were included for lower extremity DVT. Three studies with 500 patients were included for upper extremity DVT. Among patients with lower extremity DVT, 0.85% (95% confidence interval [CI], 0% to 2.10%) and 0% developed recurrent DVT and PE, respectively, at 3 months. Among patients with upper extremity DVT, 0.49% (95% CI, 0% to 1.16%) and 1.98% (95% CI, 0.62% to 3.33%) developed recurrent DVT and PE, respectively, at 3 months. No major bleeding events were reported for those anticoagulated, which is lower than in other systematic reviews. For both upper and lower extremity DVT, low pretest probability patients with a negative D-dimer had a comparable incidence of VTE at 3 months (∼1%) as patients with a negative ultrasound (US). At higher pretest probabilities, negative US testing with or without serial US appears to be the safer option. In this review, we summarized the outcomes of patients evaluated by various diagnostic pathways. In most instances, there was significant limitation due to small population size or lack of direct evidence of effects of using a specific pathway. This systematic review was registered at PROSPERO as CRD42018100502.

Application of an elevated plasma D-dimer cut-off value improves prognosis prediction of advanced non-small cell lung cancer

“…Tumor-related thrombosis has a considerable influence on the prognosis of patients with cancer. Cancer patients with VTE frequently receive longterm anticoagulant therapy before anticancer treatment, which may miss the best time for anticancer treatment, leading to a dissatisfactory treatment effect (3).…”

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Incidence and risk factors of preoperative isolated calf deep venous thrombosis following hip fractures

“…[27,28] In addition, it had been well-established that cigarette smoking was significantly associated with high plasma fibrinogen levels, leading to prolonged coagulation propensity. [29,30] The riskincreasing impact of smoking might be attributed to multiple pathways or factors it upregulates in the coagulation system, which could be partially explained by the strong relationship between smoking and the presence of ICDVT in patients with hip fractures. Although the explicit connection between cigarette smoking and ICDVT remains unclear, this clinical relevance of the smoking and occurrence of ICDVT should not be ignored, there were other benefits to dissuading inpatients from quitting smoking although smoking was not included in the relevant thrombotic risk assessment score (eg, Caprini score, Padua scores).…”

Thrombophilia, Thrombosis and Thromboprophylaxis in Pregnancy: For What and in Whom?

“…It occurs with an incidence of approximately 1 to 2 per 1,000 annually in the general population with increasing tendency. 1 2 3 4 5 Rates differ among age groups and sex. Although the incidence is approximately 1 per 10,000 in individuals younger than 40 years, the rate rises rapidly up to 1 per 100 annually in the elderly.…”