The Laterality of Deep Vein Thrombosis in the Pelvic and Lower Extremity Veins

Abstract

Purpose:This study aimed to determine whether deep vein thrombosis (DVT) predominantly occurred on a particular side in the pelvic and lower extremity veins.Materials and Methods:Among 259 consecutive patients with leg swelling, 65 were confirmed to have DVT in the pelvis and lower extremities, and enrolled in this study. The serum levels of initial D-dimer, antithrombin III, tissue plasminogen activator, factor VIII, proteins C and S, anticardiolipin antibodies immunoglobulin (Ig) G and IgM and lupus anticoagulant were measured and analyzed retrospectively. Lower extremity venous system was divided into 11 anatomic segments on each side, and thrombotic involvement in each segment was recorded to determine the laterality of thrombotic involvement for each patient. The presence of thrombus in a specific vein was assigned using a Thrombus Scoring System (TSS) score of 1. Predominant direction was determined based on the TSS score for each side.Results:Left-side predominat DVT (57%) was most frequent. Patients with both-side equivalent DVT had the highest total TSS score (P=0.022). The predominant side was significantly different between men (right 44.1%) and women (left 74.2%) (P=0.022). Patients with both-side equivalent DVT had the highest mean age (69.3±9.9 years) as well as the highest mean levels of initial D-dimer (13.8±20.7 μg/mL) and anticardiolipin antibody IgM (13.4±22.8 MPL) indicating increased coagulability.Conclusion:In the current study, left-side predominant DVT is most frequent in pelvis and lower extremities, and this phenomenon is more apparent in women. And both-side equivalent DVT is associated with the most advanced age and hypercoagulability.

Mortality and Complication Rates in Adult Trauma Patients Receiving Tranexamic Acid: A Single‐center Experience in the Post–CRASH‐2 Era

“…Older trauma patients are at a significantly higher risk for thromboembolic events compared to younger patients. 28,29 Furthermore, the peak of DVT incidence has been reported at ages between 45 and 59 years, an age group that was much more frequent in our study cohort compared to the CRASH-2 cohort. 30 In recent studies, it was demonstrated that in hospitalized older patients with traumatic brain injury (TBI) and in patients with greater TBI severity, incidence of acute thromboembolic events was significantly higher.…”

Laterality of lower extremity deep vein thrombosis after colectomy: A retrospective study using the national inpatient sample

“…Shin's study mentioned above found 57% left-sided predominance of DVT, but the finding seemed to be restricted to females who had left-predominant DVT in 74.2%. 6 The casecontrol study by Narayan et al found that female sex had odds ratio 6.41 for compression of the left iliac vein, providing an underlying cause for the observed laterality associated with female sex. 7 It has been proposed that the accentuated lordosis of the lower spine in females pushes the left iliac vein forward against the right iliac artery (briefly reviewed by Harbin et al) 24 We did not perform adjustment for multiple comparisons because all analyses were driven by specific hypotheses.…”

“…Subgroup analysis by sex was also performed as we were aware that left-side predominance in DVT is prominent in females. 6 Sex data were missing in 70 cases, leaving 68,435 cases for this subgroup analysis.…”

“…For example, 42 vs 39% left vs right among trauma patients without lateralizing injuries, and 57% left-sided DVT in another cohort. 5,6 Contradicting May and Thurner's findings, Narayan et al analyzed a cohort of patients who had undergone computed tomographic angiography of the pelvis before developing a DVT, and found that 7.2% of patients had iliac vein compression >70%, and in that group left-sided DVT was more probable with an OR of 3.03. 7 It has long been observed that DVT is part of a group of diseases known to increase incidence steeply with population transitions to Western lifestyle, the socalled "diseases of civilization."…”

Association between Laterality and Location of Deep Vein Thrombosis of Lower Extremity and Pulmonary Embolism

“…May–Thurner syndrome is three-to-eight times more frequent on the left side than on the right [ 4 , 5 ] and accounts for approximately 50%-60% of the cases of left IF DVT [ 6 , 7 ]. This condition is considered as one of the main contributors to the left-sided predominance of DVT in the lower extremity [ 8 - 10 ]; thus, correction of the mechanical compression is often necessary for patients with left-sided DVT to reduce the risk of recurrent DVT and PTS [ 11 ]. CDT is indicated only for extensive proximal DVT because of the increased risk of major bleeding events [ 12 ].…”