Below-knee deep vein thrombosis (DVT): diagnostic and treatment patterns

Fleck, Drew; Albadawi, Hassan; Wallace, Alex; Knuttinen, Grace; Naidu, Sailendra; Öklü, Rahmi

doi:10.21037/cdt.2017.11.03

Cited by 27 publications

(20 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…where surveillance is often recommended over anticoagulant treatment, though the vast majority are treated with anticoagulants 169 . However, our results did not change when we excluded patients with distal DVT from the analysis.…”

Section: Methodological Considerations Of Study IImentioning

confidence: 99%

The Silence Speaks, but We Do Not Listen: Synonymous c.1824C>T Gene Variant in the Last Exon of the Prothrombin Gene as a New Prothrombotic Risk Factor

et al. 2020

View full text Add to dashboard Cite

Background Thrombosis is a major global disease burden with almost 60% of cases related to underlying heredity and most cases still idiopathic. Synonymous single nucleotide polymorphisms (sSNPs) are considered silent and phenotypically neutral. Our previous study revealed a novel synonymous FII c.1824C>T variant as a potential risk factor for pregnancy loss, but it has not yet been associated with thrombotic diseases. Methods To determine the frequency of the FII c.1824C>T variant we have sequenced patients’ DNA. Prothrombin RNA expression was measured by quantitative PCR. Functional analyses included routine hemostasis tests, western blotting and ELISA to determine prothrombin levels in plasma, and global hemostasis assays for thrombin and fibrin generation in carriers of the FII c.1824C>T variant. Scanning electron microscopy was used to examine the structure of fibrin clots. Results Frequency of the FII c.1824C>T variant was significantly increased in patients with venous thromboembolism and cerebrovascular insult. Examination in vitro demonstrated increased expression of prothrombin mRNA in FII c.1824T transfected cells. Our ex vivo study of FII c.1824C>T carriers showed that the presence of this variant was associated with hyperprothrombinemia, hypofibrinolysis, and formation of densely packed fibrin clots resistant to fibrinolysis. Conclusion Our data indicate that FII c.1824C>T, although a synonymous variant, leads to the development of a prothrombotic phenotype and could represent a new prothrombotic risk factor. As a silent variant, FII c.1824C>T would probably be overlooked during genetic screening, and our results show that it could not be detected in routine laboratory tests.

show abstract

Section: Methodological Considerations Of Study IImentioning

confidence: 99%

The Silence Speaks, but We Do Not Listen: Synonymous c.1824C>T Gene Variant in the Last Exon of the Prothrombin Gene as a New Prothrombotic Risk Factor

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Distal DVT was the main pathology in 32% of the patients with VTE, that is, cases where surveillance is often recommended over anticoagulant treatment, though the vast majority is treated with anticoagulants. 40 However, our results did not change when we excluded patients with distal DVT from the analysis.…”

Section: Limitationsmentioning

confidence: 59%

Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers

Farm

Antovič

Schmidt

et al. 2020

TH Open

View full text Add to dashboard Cite

Introduction For acute venous thromboembolism (VTE), a biomarker with higher specificity than D-dimer would be of great clinical use. Thrombin generation and overall hemostatic potential (OHP) reflect the hemostatic balance by globally assessing multiple coagulation factors and inhibitors. These tests discriminate between healthy controls and patients with a prothrombotic tendency but have yet to be established as clinical biomarkers of VTE. Objective This study compares endogenous thrombin potential (ETP) and OHP to D-dimer and fibrin monomers (FM) in outpatients with suspected VTE. Methods A cross-sectional diagnostic study where 954 patients with suspected pulmonary embolism or deep venous thrombosis were recruited consecutively from the medical emergency department at Karolinska University Hospital. D-dimer, FM, OHP, and ETP were analyzed in a subpopulation of 60 patients with VTE and 98 matched controls without VTE. VTE was verified either by ultrasonography or computed tomography and clinical data were collected from medical records. Results Compared with healthy controls, both VTE and non-VTE patients displayed prothrombotic profiles in OHP and ETP. D-dimer, FM, ETP area under the curve (AUC), and ETP Tlag were significantly different between patients with VTE and non-VTE. The largest receiver-operating characteristic AUCs for discrimination between VTE and non-VTE, were found in D-dimer with 0.94, FM 0.77, and ETP AUC 0.65. No useful cutoff could be identified for the ETP or the OHP assay. Conclusion Compared with D-dimer, neither ETP nor OHP were clinically viable biomarkers of acute venous thrombosis. The data indicated that a large portion of the emergency patients with suspected VTE were in a prothrombotic state.

show abstract

“…There is no consensus on the use of anticoagulant therapy on asymptomatic infrapopliteal DVT in COVID-19 patients because of the lower probability of thrombus migration into the lungs, and some groups prefer expectant management (13), while others propose using anticoagulant therapy (14). The indication of treatment depends on the clinical context of each patient.…”

Section: Discussionmentioning

confidence: 99%

Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

Alfageme

Plaza

Collado

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundCOVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE).MethodsThe purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n=23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU).ResultsDVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. CTPA was performed in 6 patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy.ConclusionIn critically COVID 19 ill ICU patients with severe respiratory failure y elevated D-dimer the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulated these patients.

show abstract

Below-knee deep vein thrombosis (DVT): diagnostic and treatment patterns

Cited by 27 publications

References 24 publications

The Silence Speaks, but We Do Not Listen: Synonymous c.1824C>T Gene Variant in the Last Exon of the Prothrombin Gene as a New Prothrombotic Risk Factor

The Silence Speaks, but We Do Not Listen: Synonymous c.1824C>T Gene Variant in the Last Exon of the Prothrombin Gene as a New Prothrombotic Risk Factor

Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers

Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

Contact Info

Product

Resources

About

Below-knee deep vein thrombosis (DVT): diagnostic and treatment patterns

Cited by 27 publications

References 24 publications

The Silence Speaks, but We Do Not Listen: Synonymous c.1824C&gt;T Gene Variant in the Last Exon of the Prothrombin Gene as a New Prothrombotic Risk Factor

The Silence Speaks, but We Do Not Listen: Synonymous c.1824C&gt;T Gene Variant in the Last Exon of the Prothrombin Gene as a New Prothrombotic Risk Factor

Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers

Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

Contact Info

Product

Resources

About

The Silence Speaks, but We Do Not Listen: Synonymous c.1824C>T Gene Variant in the Last Exon of the Prothrombin Gene as a New Prothrombotic Risk Factor

The Silence Speaks, but We Do Not Listen: Synonymous c.1824C>T Gene Variant in the Last Exon of the Prothrombin Gene as a New Prothrombotic Risk Factor