Asymptomatic and symptomatic deep venous thrombosis in hospitalized acutely ill medical patients: risk factors and therapeutic implications.
Anticoagulants
Asymptomatic deep venous thrombosis
Compression ultrasound
Deep venous thrombosis
Medical patient
Journal
Thrombosis journal
ISSN: 1477-9560
Titre abrégé: Thromb J
Pays: England
ID NLM: 101170542
Informations de publication
Date de publication:
30 Nov 2022
30 Nov 2022
Historique:
received:
28
04
2022
accepted:
13
11
2022
entrez:
30
11
2022
pubmed:
1
12
2022
medline:
1
12
2022
Statut:
epublish
Résumé
Acutely ill medical patients experience deep venous thrombosis (DVT) during the hospitalization, however the time course of DVT is still unclear. To evaluate risk factors in acutely ill hospitalized medical patients for proximal asymptomatic DVT (ADVT) and symptomatic DVT (SDVT) at admission and discharge. In this prospective observational study, consecutive acutely ill medical patients (hospitalized mainly for acute medical disease as infections, neoplasm, anemia, heart failure) underwent compression ultrasonography (CUS) of proximal lower limb veins within 48 h from admission and at discharge to diagnose ADVT and SDVT. Covid-19 patients, anticoagulant therapy, surgical procedures, acute SDVT, and acute pulmonary embolism, were exclusion criteria. Biographical characteristics at hospitalization, D-Dimer (assessed by ELISA)) and DD-improve score. Of 2,100 patients (1002 females, 998 males, age 71 ± 16 years) 58 (2.7%) had proximal ADVT at admission. Logistic regression analysis showed that age, and active cancer were independently associated with ADVT at admission. The median length of hospitalization was 10 days [interquartile range: 6-15]. During the hospital stay, 6 patients (0.3%) with a negative CUS at admission experienced DVT (2 SDVT and 4 ADVT). In the subgroup of patients (n = 1118), in whom D-dimer was measured at admission, D-Dimer and IMPROVE-DD score were associated with ADVT at admission (n = 37) and with all DVT (n = 42) at discharge. ROC curve defined an IMPROVE-DD score of 2.5 as the optimal cut-off for discriminating patients with and without thrombotic events. We provide evidence of early development of ADVT in unselected acutely ill medical patients suggesting the need of investigating patients by CUS immediately after hospital admission (within 48 h). Advanced age, active cancer, known thrombophilia and increased IMPROVE-DD score may identify patients at risk. The benefit of anticoagulation needs to be investigated in patients with these specific risk factors and negative CUS at admission. NCT03157843.
Sections du résumé
BACKGROUND
BACKGROUND
Acutely ill medical patients experience deep venous thrombosis (DVT) during the hospitalization, however the time course of DVT is still unclear.
OBJECTIVES
OBJECTIVE
To evaluate risk factors in acutely ill hospitalized medical patients for proximal asymptomatic DVT (ADVT) and symptomatic DVT (SDVT) at admission and discharge.
PATIENTS/METHODS
METHODS
In this prospective observational study, consecutive acutely ill medical patients (hospitalized mainly for acute medical disease as infections, neoplasm, anemia, heart failure) underwent compression ultrasonography (CUS) of proximal lower limb veins within 48 h from admission and at discharge to diagnose ADVT and SDVT. Covid-19 patients, anticoagulant therapy, surgical procedures, acute SDVT, and acute pulmonary embolism, were exclusion criteria. Biographical characteristics at hospitalization, D-Dimer (assessed by ELISA)) and DD-improve score.
RESULTS
RESULTS
Of 2,100 patients (1002 females, 998 males, age 71 ± 16 years) 58 (2.7%) had proximal ADVT at admission. Logistic regression analysis showed that age, and active cancer were independently associated with ADVT at admission. The median length of hospitalization was 10 days [interquartile range: 6-15]. During the hospital stay, 6 patients (0.3%) with a negative CUS at admission experienced DVT (2 SDVT and 4 ADVT). In the subgroup of patients (n = 1118), in whom D-dimer was measured at admission, D-Dimer and IMPROVE-DD score were associated with ADVT at admission (n = 37) and with all DVT (n = 42) at discharge. ROC curve defined an IMPROVE-DD score of 2.5 as the optimal cut-off for discriminating patients with and without thrombotic events.
CONCLUSIONS
CONCLUSIONS
We provide evidence of early development of ADVT in unselected acutely ill medical patients suggesting the need of investigating patients by CUS immediately after hospital admission (within 48 h). Advanced age, active cancer, known thrombophilia and increased IMPROVE-DD score may identify patients at risk. The benefit of anticoagulation needs to be investigated in patients with these specific risk factors and negative CUS at admission.
TRIAL REGISTRATION
BACKGROUND
NCT03157843.
Identifiants
pubmed: 36451162
doi: 10.1186/s12959-022-00433-8
pii: 10.1186/s12959-022-00433-8
pmc: PMC9709753
doi:
Banques de données
ClinicalTrials.gov
['NCT03157843']
Types de publication
Journal Article
Langues
eng
Pagination
72Subventions
Organisme : Università degli Studi di ROMA "la Sapienza"
ID : Università degli Studi di ROMA "la Sapienza" Progetti di COOPERAZIONE E SVILUPPO 2021 to LL
Investigateurs
Marco Antonio Casciaro
(MA)
Sergio Morelli
(S)
Daniele Accapezzato
(D)
Elisabetta Rossi
(E)
Ilaria Maria Palumbo
(IM)
Arianna Pannunzio
(A)
Alessia Fallarino
(A)
Enrico Maggio
(E)
Valeria Proietti Bocchini
(VP)
Chiara Gioia
(C)
Raffaella Izzo
(R)
Raffaella Luongo
(R)
Mattia Cosenza
(M)
Maria Francesca Bisciglia
(MF)
Simona Battaglia
(S)
Lohengrin Stefania Pirillo
(LS)
Alessandro Capozza
(A)
Maria Luna Summa
(ML)
Giuseppe Armentaro
(G)
Mara Volpentesta
(M)
Raissa Rullo
(R)
Lorenzo Baldinia
(L)
Vincenzo Arienti
(V)
Pier Luigi Meloni
(PL)
Assunta Sauchella
(A)
Sara Melis
(S)
Maria Berria
(M)
Beatrice Solinas
(B)
Luca Vilardi
(L)
Paola Sarobba
(P)
Manuela Pisanu
(M)
Paolo Mangatia
(P)
Maurizio Cringoli
(M)
Deborah Blanca
(D)
Francesco Casella
(F)
Alberto Vegetti
(A)
Andrea Crociani
(A)
Emilia Donnarumma
(E)
Giulia Pacciani
(G)
Rossella Rovereto
(R)
Sarah Lunardi
(S)
Antonella Tufano
(A)
Veronica Pacetti
(V)
Marco Domenicali
(M)
Pier Leopoldo
(P)
Fabrizio Ceci
(F)
Informations de copyright
© 2022. The Author(s).
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