Concept: Deep vein
Family history of venous thromboembolism (VTE) has been suggested to be more useful in risk assessment than thrombophilia testing.
Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence-based lens
- BJOG : an international journal of obstetrics and gynaecology
- Published almost 2 years ago
Based on prediction models and expert opinion, most obstetric venous thromboembolism guidelines recommend low-molecular-weight heparin for many postpartum women, including most delivering by caesarean. Scrutiny reveals major oversights: prediction models are based on studies that report asymptomatic deep vein thrombosis; risk estimates are not adjusted for time exposure; and harm caused by heparin has been overlooked. The benefits of heparin are exaggerated and its harms are under-appreciated. Estimates of the numbers-needed-to-treat and harm are universally lacking. This paper critically reviews the evidence and quantifies the benefit and harm from low-molecular-weight heparin in postpartum women with common risk factors.
The incidence of pediatric venous thromboembolism (VTE) has been increasing significantly in incidence over the past decade in part as a result of increased recognition of this serious disorder but more so due to the increased use of central venous catheters and other technological advancements involved in the care of ill children. Management of pediatric VTE is a complex undertaking considering that the vast majority of children who develop this complication have serious underlying medical disorders. Although the incidence is rising, compared to adults, this remains a relatively rare disorder and as such large scale clinical trials have not been completed rendering management decisions to be based upon extrapolation from adult data and the experience of the treating physician. Clearly both are fraught with problems. Thus, day to day management remains more art than science until such time that the results from clinical trials (many of which are under way) become available. This edition of “How I Treat” will describe the author’s experience in managing 3 common scenarios one may encounter in pediatric thrombosis and suggest a logical approach to such situations. Furthermore, the author provides 3 algorithms to help guide management decisions.
To investigate the roles of MMP3 gene polymorphism and protein expression in deep venous thrombosis (DVT) among Chinese Han population.
The risk of venous thromboembolism (VTE) is high during pregnancy. Although most patients with VTE are safely treated via medications, the optimal treatment for massive pulmonary embolism remains controversial. To evaluate the safety and efficacy of VTE management during pregnancy, we report our single center experience of treating VTE in pregnant women.
Two cases of compartment syndrome of the lower extremities occurring during surgery for gynecological malignancies are reported. In addition to the risk from being in the lithotomy position for over 4 h, these two cases were believed to have been caused by the combined use of a disposable wound retractor and abdominal retractors to secure the operative field. This conclusion is based on the fact that an abrupt increase in partial pressure of end-tidal CO2 (ETCO2) was observed when wound drapes and abdominal retractors were removed approximately 4 h after the start of surgery. Prolonged compression of the external iliac vein by a disposable wound retractor and abdominal retractors is believed to have induced congestion of the lower extremities, eventually resulting in compartment syndrome. To verify this, during subsequent surgeries of the same type, changes in the diameters of femoral arteries and veins when a disposable wound retractor and abdominal retractors were used were monitored using an ultrasound device, and the findings confirmed that changes in vascular diameter do occur.
It is well established that high intensity focused ultrasound can be used to disintegrate clots. This approach has the potential to rapidly and noninvasively resolve clot causing occlusions in cardiovascular diseases such as deep vein thrombosis (DVT). However, lack of an appropriate treatment monitoring tool is currently a limiting factor in its widespread adoption. Here we conduct cavitation imaging with a large aperture, sparse hemispherical receiver array during sonothrombolysis with multi-cycle burst exposures (0.1 or 1 ms burst lengths) at 1.51 MHz. It was found that bubble cloud generation on imaging correlated with the locations of clot degradation, as identified with high frequency (30 MHz) ultrasound following exposures. 3D images could be formed at integration times as short as 1 µs, revealing the initiation and rapid development of cavitation clouds. Equating to megahertz frame rates, this is an order of magnitude faster than any other imaging technique available for in vivo application. Collectively, these results suggest that the development of a device to perform DVT therapy procedures would benefit greatly from the integration of receivers tailored to bubble activity imaging.
Qualitative Slow Blood Flow in Lower Extremity Deep Veins on Doppler Sonography: Quantitative Assessment and Preliminary Evaluation of Correlation With Subsequent Deep Venous Thrombosis Development in a Tertiary Care Oncology Center
- Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
- Published over 2 years ago
To determine whether the qualitative sonographic appearance of slow deep venous flow in the lower extremities correlates with quantitative slow flow and an increased risk of deep venous thrombosis (DVT) in oncology patients.
Symptoms suggestive of deep vein thrombosis (DVT) are extremely common in clinical practice, but unfortunately nonspecific. In both ambulatory and inpatient settings, clinicians are often tasked with evaluating these concerns. Here, we review the most recent advances in biomarkers and imaging to diagnose lower extremity DVT.
Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography. Some applications of POCUS unique to the emergency department include abdominal ultrasonography of the right upper quadrant and appendix, obstetric, testicular, soft tissue/musculoskeletal, and ocular ultrasonography. Ultrasonography has become an integral part of EM over the past two decades, and it is an important skill which positively influences patient outcomes.