The anatomic distribution and pulmonary embolism complications of hospital-acquired lower extremity deep venous thrombosis

Qiu, Tao; Zhang, Tao; Liu, Lei; Li, Wei; Li, Qingle; Zhang, Xuemin; Yang, Jicheng; Li, Weihao; Ma, Haocheng; Zhang, Xiao Ming

doi:10.1016/j.jvsv.2021.03.004

Cited by 16 publications

(19 citation statements)

References 36 publications

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“…In another international, prospective, observational WHITE study, 10.21% of LEDVT patients had confirmed concomitant PE ( 34 ). After the diagnosis of LEDVT, we found the proportion of PE among LEDVT patients was 7.83%, which was lower than the above-mentioned ( 33 , 34 ), but slightly higher than that reported in another study (6.15%) ( 16 ).…”

Section: Discussioncontrasting

confidence: 77%

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Anatomic distribution of lower extremity deep venous thrombosis is associated with an increased risk of pulmonary embolism: A 10-year retrospective analysis

Zhang

Chen

Wang

et al. 2023

Front. Cardiovasc. Med.

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AimsTo investigate the potential relationship between anatomic distribution of lower extremity deep venous thrombosis (LEDVT) and pulmonary embolism (PE).MethodsA retrospective case-control study was performed in patients diagnosed with LEDVT, which were confirmed by bilateral lower extremity compression ultrasonography (CUS) examination. According to the ultrasound reports, thrombus sidedness was categorized as unilateral and bilateral lower extremity, thrombus location was classified into distal and proximal LEDVT. Anatomic distributions of LEDVT were further subdivided depending on the combination of thrombus sidedness and location. Patients with PE were identified using the International Classification of Diseases-10 (ICD-10) codes (I26.0 and I26.9), and divided into PE group and Non-PE group. Univariate and multivariate logistic regression analyses were used to assess the association between anatomic distribution of LEDVT and PE. Sensitivity analyses were also conducted.ResultsA total of 2,363 consecutive patients with LEDVT were included, of whom 66.10% and 33.90% were unilateral and bilateral LEDVT, as well as 71.39% and 28.61% were isolated distal and proximal LEDVT, respectively. After the diagnosis of LEDVT, 185 patients (7.83%) developed PE. The proportions of PE ranged between the lowest (4.07%) in unilateral-distal LEDVT and highest (14.55%) in bilateral-proximal LEDVT. Multivariate logistic regression analysis showed that bilateral LEDVT (odds ratios [OR] = 2.455, 95% confidence interval [CI]: 1.803–3.344, P < 0.001) and proximal LEDVT (OR = 1.530, 95% CI: 1.105–2.118, P = 0.010) were risk factors for developing PE. Moreover, unilateral-proximal (OR = 2.129, 95% CI: 1.365–3.320, P = 0.00), bilateral-distal (OR = 3.193, 95% CI: 2.146–4.752, P < 0.001) and bilateral-proximal LEDVT(OR = 3.425, 95% CI: 2.093–5.603, P < 0.001) were significantly associated with an increased risk of PE. Sensitivity analyses also confirmed the robustness of these associations.ConclusionPatients with unilateral-proximal, bilateral-distal or bilateral-proximal are more likely to suffer from PE than those with unilateral-distal LEDVT.

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Section: Discussioncontrasting

confidence: 77%

“…Recently, the occurrence of PE seems to be closely related to the anatomic distribution of lower extremity DVT (LEDVT) ( 16 , 17 ). In general, isolated distal LEDVT is presumed to be more benign than proximal LEDVT, presenting a lower risk of PE, VTE recurrence, post-thrombotic syndrome and mortality ( 18 – 20 ).…”

Section: Introductionmentioning

confidence: 99%

Anatomic distribution of lower extremity deep venous thrombosis is associated with an increased risk of pulmonary embolism: A 10-year retrospective analysis

Zhang

Chen

Wang

et al. 2023

Front. Cardiovasc. Med.

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“…The reported prevalence of PE concurrent with isolated calf DVT has ranged from 0% to 6.2%. 6 However, the included studies were heterogeneous in the imaging protocol used and diagnosis time points after isolated calf DVT. The present study included only hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

“…5 A recent study found the muscular calf veins were the most frequently involved veins in hospital-acquired DVT and might be the origin of the DVT. 6 Sartori et al 7 also showed that isolated calf DVT was more prevalent than proximal DVT in hospitalized patients. Although it has been widely accepted that, overall, isolated calf DVT will be benign and self-limiting, the clinical significance of isolated calf DVT could be different for hospitalized patients.…”

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confidence: 98%

Clinical presentation of isolated calf deep vein thrombosis in inpatients and prevalence of associated pulmonary embolism

Kim

2022

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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“…If not timely diagnosed or treated, DVT would develop into post-thrombotic syndrome, which leads to ulcers, necrosis, and pigmentation in lower limbs ( Galanaud et al, 2018 ). Furthermore, due to the sizeable vascular diameter of the proximal lower extremity, the thrombus in this site is prone to dislodge and develop into fatal pulmonary thromboembolism (PE) ( Qiu et al, 2021 ). Therefore, to reduce the incidence and mortality of DVT and ease the socioeconomic stress, there is an urgent demand for discovering predictors of DVT and taking corresponding precautions in the perioperative period of spine surgery besides improving the diagnostic technique ( Le Gal et al, 2017 ; Ruskin, 2018 ; Wang et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

A prospective marker for the prediction of postoperative deep venous thrombosis: Neutrophil extracellular traps

Yin

Jiang²,

Zhou³

et al. 2022

Front. Cell Dev. Biol.

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Deep venous thrombosis (DVT) is a common medical complication in patients with lumbar fractures. The current study aimed to investigate the predictive value of neutrophil extracellular traps (NETs) in postoperative DVT formation in patients with lumbar fractures and to develop a nomogram relating clinical admission information for prediction. Patients who underwent open reduction and pedicle screw internal fixation in the treatment of single-segment lumbar fracture in the Department of Spine Surgery, the First Affiliated Hospital of Nanjing Medical University, from December 2020 to June 2022 were enrolled in this study. Baseline data and laboratory results were collected from enrollees, and the primary study endpoint event was the occurrence of DVT in patients after surgery. Multivariable logistic regression analysis was used to identify risk factors associated with higher odds of DVT after surgery. A nomogram was constructed using the results of the multivariable model. The calibration plot and receiver operating characteristics (ROC) curve were used to show the satisfactory predictive capacity of the model. Of these 393 patients who did not have DVT preoperatively, 79 patients developed it postoperatively, and 314 did not, respectively. Multivariate analysis showed that higher body mass index (BMI) (BMI between 24 and 28: RR = 1.661, 95% CI = 0.891–3.094; BMI ≤28: RR = 5.625, 95% CI = 2.590–12.217; reference: BMI <24), neutrophils (RR = 1.157, 95% CI 1.042–1.285), D-dimer (RR = 1.098, 95% CI 1.000–1.206), and citrullinated histone H3 (CitH3) (RR = 1.043, 95% CI 1.026–1.060) were independent risk factors for postoperative DVT. Using the multivariable analysis, we then constructed a nomogram to predict DVT, which was found to have an area under the curve of 0.757 (95% CI = 0.693–0.820). Calibration plots also showed the satisfied discrimination and calibration of the nomogram. In conclusion, patients with lumbar fractures with postoperative DVT had higher levels of NETs in the circulation preoperatively compared to those without postoperative DVT. Furthermore, based on BMI, D-dimer, neutrophils, and CitH3, we developed a predictive model to predict postoperative DVT incidence in these patients.

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The anatomic distribution and pulmonary embolism complications of hospital-acquired lower extremity deep venous thrombosis

Cited by 16 publications

References 36 publications

Anatomic distribution of lower extremity deep venous thrombosis is associated with an increased risk of pulmonary embolism: A 10-year retrospective analysis

Anatomic distribution of lower extremity deep venous thrombosis is associated with an increased risk of pulmonary embolism: A 10-year retrospective analysis

Clinical presentation of isolated calf deep vein thrombosis in inpatients and prevalence of associated pulmonary embolism

A prospective marker for the prediction of postoperative deep venous thrombosis: Neutrophil extracellular traps

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