Incidence of venous thromboembolism verified by necropsy over 30 years.

Lindblad, Bengt; Sternby, Nils H.; Bergqvist, David

doi:10.1136/bmj.302.6778.709

Cited by 353 publications

(209 citation statements)

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“…2 However, because of the variety of risk factors in these patients and their individual health problems (e.g., comorbidities, therapies), 3 the guidelines formulated for these cases are scarcely applied. The type of procedure as well as trauma are crucial for VTE in surgical patients (general surgery, gynecology, and orthopedics).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, predictive algorithms that should help to identify high-risk subjects (i.e., those who require intensive prophylaxis) have been defined. 2,4 Appropriate use of the guidelines is thus an opportunity to decrease mortality and morbidity rates in this setting. 2,5,6 We have considered that, in addition to appropriate knowledge of the issue, the availability of specific technical resources in each health-care structure may affect dramatically the way guidelines are applied.…”

Section: Introductionmentioning

confidence: 99%

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Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Franciscis¹,

Agus²,

Bisacci³

et al. 2008

Annals of Vascular Surgery

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Venous thromboembolism (VTE) is a common health problem for today's society, and considering the role that it plays in surgical patients (general surgery, gynecology, and orthopedics), new advances in our understanding of the procedures and trauma characteristics are relevant and necessary. The most important and recently published guidelines concerning this problem have been taken into consideration, leading to articulate investigations and data evaluation. This project has proposed a data-survey framework available as a questionnaire in order to investigate application of the guidelines for VTE throughout the national territory. Of the total 714 Italian centers, a random sample of 214 were contacted and asked to take part in this study; of these, 146 replied (20.4% of total and 68.2% of the sample): 48 departments of general surgery, 46 departments of gynecology, and 52 departments of orthopedics. About 70% of the centers has appropriate information about surgery as a risk factor for VTE. The answers have provided evidence of an adequate knowledge of the instrumental and laboratory diagnostic pathways, useful to confirm the diagnosis of TE (80%). Data waiting compared with morbidity and mortality rates related to deep vein thrombosis and pulmonary embolism showed an increase of mortality associated with the diagnostic data timing of supply, with an exponential trend linked to the data acquisition delay. Both risk stratification and adequate application of prophylaxis together with treatment devices represent a real tool to control morbidity and mortality for VTE. Moreover, diagnostic data waiting significantly influences adequate prophylaxis. In Italy, only 40% of the centers are ready to provide diagnostic data within 12 hr.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Franciscis¹,

Agus²,

Bisacci³

et al. 2008

Annals of Vascular Surgery

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confidence: 99%

“…To investigate this issue we reviewed the scientific background which prompted to plan interventional trials with anticoagulants. The studies were essentially necropsy analysis of patients hospitalized in internal medicine wards, who died from pulmonary embolism [1][2][3][4]. In a large study performed in different clinical settings it appeared that patients hospitalized in the department of internal medicine had an even higher risk of developing pulmonary embolism compared to other departments including that of general surgery, infectious disease, oncology and orthopaedics [1].…”

mentioning

confidence: 99%

“…The studies were essentially necropsy analysis of patients hospitalized in internal medicine wards, who died from pulmonary embolism [1][2][3][4]. In a large study performed in different clinical settings it appeared that patients hospitalized in the department of internal medicine had an even higher risk of developing pulmonary embolism compared to other departments including that of general surgery, infectious disease, oncology and orthopaedics [1]. Apart from the retrospective nature of these analyses, it should be underscored that none of these studies provided clinical details of the medical illness which predisposed to venous thromboembolism; in rare cases a list of concomitant medical diseases was reported.…”

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confidence: 99%

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Interventional trials with anticoagulants in acutely ill medical patients: a methodological pitfall?

Violi

Perri

2013

Intern Emerg Med

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Autopsy and retrospective studies [1][2][3][4] lead to believe that patients hospitalized for acute medical illness are at higher risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) and that anticoagulant treatment was, therefore, necessary to prevent such vascular outcomes. Interventional trials consistently showed that prophylaxis with anticoagulants reduces the risk of composite endpoints of DVT, PE and DVT-related death in patients hospitalized for acute medical illness while no effect has been detected for total mortality [5]. These results prompted to recommend the use of anticoagulant prophylaxis in patients hospitalized for acute medical illness [6], but despite this, there is a large underuse of anticoagulant prophylaxis in the medical wards of hospitals [7,8].The scarce use of anticoagulants in acutely ill medical is almost evident in a multicenter clinical registry (The REPOSI study) performed by investigating patients hospitalized in Italian divisions of internal medicine [9].Thus, Marcucci et al.[9] included 1,121 acutely ill medical patients and followed them up during the hospital stay and until 3 months after hospital discharge. Patients included were very old, with a mean age of 82 years; males and females were equally distributed. Among 1,121 patients, 171 (15.2 %) were treated with thromboprophylaxis (TP) including low molecular weight heparin (n = 158), unfractionated heparin (n = 4) and fondaparinux (n = 9). Administration of anticoagulants was unrelated to the current guidelines of this setting as only 14.9 % of treated patients met the criteria of ACCP 2004 guidelines [10]. Among the putative risk factors considered, impaired global performance, as assessed by Barthel index [11], length of hospital stay and acute respiratory failure were independent predictors of TP during the hospitalization.Because the rate of patients treated with TP was low, the study offers an interesting chance to appreciate the rate of DVT in a relatively large population of acutely ill medical patients. Figure 1 depicts the rate of DVT in patients treated or not with TP. During the hospital stay among 950 untreated patients, DVT was diagnosed in 5 (0.5 %) while 1 (0.6 %) DVT was observed in the 171 treated patients; in the 3-month follow-up only three untreated and one treated patients experienced DVT. Taking into account the entire follow-up, 8 (0.8 %) untreated and 2 (1.1) treated patients experienced DVT. Pulmonary embolism was detected in two patients with DVT (one treated and one untreated) only after hospital discharge.We have recently reviewed the incidence of DVT in the interventional trials with anticoagulants performed in acutely ill medical patients [12].The rate of DVT was quite different if symptomatic or asymptomatic events were separately considered [12]. Thus, asymptomatic DVT was much more frequent compared to symptomatic ones with a large variation ranging as high as 28 % to as low as 2.3 % with an average of 4.7 % [12]. The rate of symptomatic DVT was much less with values from as hi...

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An Epidemiologic Study of Risk Factors for Deep Vein Thrombosis in Medical Outpatients

2000

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Incidence of venous thromboembolism verified by necropsy over 30 years.

Cited by 353 publications

References 2 publications

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Interventional trials with anticoagulants in acutely ill medical patients: a methodological pitfall?

An Epidemiologic Study of Risk Factors for Deep Vein Thrombosis in Medical Outpatients

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