Venous Thromboembolism During Ten-year Follow up on Clinical Center University of Sarajevo

Abstract

Introduction: Venous thromboembolism (VTE) consists of two entities, deep venous thrombosis (DVT), and its complication, pulmonary embolism (PE). The main therapeutic goal is the prevention of this complication. Aim: The aim of the study was to present epidemiological data of patients with the diagnosis of deep venous thrombosis, with regard to the location of thrombosis, the value of fibrinogen and D-dimer in relation to the sex of the patients, the presentation of therapeutic modality, with the presentation of PE and treatment outcomes. Methods: The study has a retrospective and observational feature, covering the period from 2008 to 2017, and included 1154 patients with the diagnosis of deep venous thrombosis as a basic criterion for inclusion. Data on sex, age, diagnosis with thrombosis localization, hospitalization duration, administered therapy, D-dimer and fibrinogen values, pulmonary thromboembolism and mortality were collected. Results: The deep venous thrombosis was mostly located at the lower limbs - in 1079 respondents (93.5%), then at the upper limbs in 65 (5.63%) cases. The left side is more represented (58.9%) than the right (40.3%), which is statistically significant (χ 2 =40.03, p<0.005), while 0.9% of patients had DVT bilaterally. At the lower limbs is the most common iliac thrombosis, represented in 47% of thrombosis cases at the lower limbs. Subclavian axillary thrombosis has been reported in ¾ cases at the upper limbs. The mean fibrinogen concentration in all respondents is 5.2 mg/L, for men 5.0 mg/L and for women 5.3 mg/L, above the reference values (1.8-3.8 g/L). The mean value of D-dimer was 7.33 mg/L for all respondents, 8.46 mg/L for women and 6.5 mg/L for men, which was high above the reference limit (0.55 mg/L). From baseline, 88 (7.6%) of respondents had proven/high-grade pulmonary thromboembolism as a DVT complication in the observed period. Pearson correlation established a positive correlation between lethal outcome and patient age, r=0.13, p<0.005, followed by a higher incidence of lethal outcome after DVT in older patients. Conclusion: The incidence of venous thromboembolism is approximately equal among the genders, and increases with the age of the patients, especially in men. Fibrinogen and D-dimer values in hospitalized patients are higher than the reference, in both cases more among women. Multidisciplinary approach to patients, in cooperation with angiologists, pulmonologists, cardiologists and nuclear medicine specialists is an imperative. The development of a state-level registry that would follow the incidence of deep venous thrombosis, with reference to risk factors, is imperative and necessary in planning of community health system.

D-Dimer and Fibrinogen Values according to the Localization of Deep Venous Thrombosis

“…The aim of treatment is prevention of thrombus embolization, establishment of hemodynamic stability, recanalization of thrombosed blood vessels, prevention or reduction of chronic pulmonary hypertension, and prevention of long-term complications of VTE. 21 Our study confirmed equal gender distribution of DVT and that proximal DVT (now divided into femoral-popliteal and iliofemoral DVT) is much more common than isolated calf DVT and UEDVT, which is consistent with previous data. 17,19 Our results also show that D-dimer and fibrinogen levels are significantly higher in patients with proximal clots than those with distal clots.…”

“…The aim of treatment is prevention of thrombus embolization, establishment of hemodynamic stability, recanalization of thrombosed blood vessels, prevention or reduction of chronic pulmonary hypertension, and prevention of long-term complications of VTE. 21…”

“…Available data show that more than 95% of PE are formed by thrombi located in the deep veins of the lower extremities. 21 Larger leg veins (popliteal vein and veins above it) are a much more common source of PE, which are of clinical interest, and PE should be considered the most serious complication of DVT. 4 21 The diagnosis is made on the basis of anamnestic data, clinical findings, determination of coagulation parameters (nonspecific), and D-dimer (elevated values do not immediately mean thrombosis, but normal values probably exclude it).…”

“…High-risk patients should receive full-dose anticoagulation, for at least 3 months, as for proximal DVT. 21 The aim of the article was to present the values of D-dimer and fibrinogen in relation to the anatomical localization of DVT.…”

“…High-risk patients should receive full-dose anticoagulation, for at least 3 months, as for proximal DVT. 21…”