Posttraumatic Deep Vein Thrombosis in Collegiate Athletes: An Exploration Clinical Case Series (original) (raw)
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Risk Assessment in Venous ThromboEmbolism
Journal of Theoretical and Applied Vascular Research
Clinical pre-test probability scores are used to guide the subsequent steps in the diagnosis and therapy of venous thromboembolism. However, often there is resistance in accepting formal and standardized procedures as a substitute of expert judgements. A review of the available tools as well as of the laboratory and imaging techniques is presented, together with the detailed report of a comprehensive debate held on the Vasculab Mailing List. Several unusual topics came to attention during the discussion: as the validation of scores, limited to a few contexts and populations; the over-utilization of venous duplex ultrasound and the rational use of resources; how to choose the steps, managing the amount of time waiting for the results of a test; the scarce attention given today to the long term complications, like the chronic pulmonary embolism, the pulmonary hypertension and the postthrombotic syndrome. A lot of open problems of course remains, the report being witness of the value of a free style atypical discussion, as generally occurs on Vasculab.
Deep venous thrombosis and pulmonary embolism. Frequency in a respiratory intensive care unit
JAMA: The Journal of the American Medical Association, 1981
Deep venous thrombosis (DVT) and pulmonary embolism (PE) affect high-risk trauma patients (HRTP). Accurate incidence and clinical importance of DVT and PE in HRPT may be overstated. We performed a ten-year retrospective analysis of HRTP of the Pennsylvania Trauma Outcome Study. High-risk factors (HRF) included pelvic fracture (PFx), lower extremity fracture (LEEx), severe head injury (CHI) (AIS -head >3), and spinal cord injury. HRF alone or in combination, age, Injury Severity Score {ISS), and Glasgow Coma Score (GCS) were examined for association with DVT/PE. A total of 73,419 HRTP were included: 1377 (1.9%) had DVT, 365 (0.5%) had PE. The incidence of DVT in level I trauma centers was 2.2 per cent and was 1.5 per cent in level II centers. The lowest incidence of DVT was 1.3 per cent for isolated LEEx; highest was 5.4% for combined PFx, LEEx, and CHI. Variables associated with DVT included age, ISS, and GCS (all P < 0.001). In logistic regression analysis, only ISS was consistently predictive for DVT and PE. Though increased during the past decade, the overall incidence of DVT in HRTP remains below 3 per cent. Only the combination of multiple injuries or an ISS >30 result in DVT incidence of >5 per cent. We believe that current guidelines for screening for DVT may need to be reevaluated.
The journal of trauma and acute care surgery, 2013
The traditional paradigm is that deep venous thrombosis (DVT) and pulmonary embolus (PE) are different temporal phases of a single disease process, most often labeled as the composite end point venous thromboembolism (VTE). However, we theorize that after severe blunt injury, DVT and PE may represent independent thrombotic entities rather than different stages of a single pathophysiologic process and therefore exhibit different clinical risk factor profiles. We examined a large, multicenter prospective cohort of severely injured blunt trauma patients to compare clinical risk factors for DVT and PE, including indicators of injury severity, shock, resuscitation parameters, comorbidities, and VTE prophylaxis. Independent risk factors for each outcome were determined by cross-validated logistic regression modeling using advanced exhaustive model search procedures. The study cohort consisted of 1,822 severely injured blunt trauma patients (median Injury Severity Score [ISS], 33; median b...
Overview of venous thromboembolism
The American journal of managed care, 2017
Venous thromboembolism (VTE) describes the diagnoses of deep vein thrombosis (DVT) or pulmonary embolism (PE). DVT is the formation of thrombi in the deep veins, most commonly the large veins of the legs or pelvis. PE develops when thrombi dislodge from clots in vein walls and travel through the heart to pulmonary arteries. In many patients, the presenting manifestation of PE is sudden death. VTE may be categorized as provoked or unprovoked. This categorization influences the risk of recurrent VTE and duration of anticoagulation therapy. It is important for primary care providers to clearly understand the pathogenesis and causes of thrombosis in order to create evidence-based therapeutic and prophylactic patient care plans that adequately prevent recurrent VTE.
Venous Thromboembolism: Classification, Risk Factors, Diagnosis, and Management
ISRN Hematology, 2011
Venous thromboembolism (VTE) is categorised as deep venous thrombosis (DVT) and pulmonary embolism (PE). VTE is associated with high morbidity and causes a huge financial burden on patients, hospitals, and governments. Both acquired and hereditary risks factors contribute to VTE. To diagnose VTE, noninvasive cost-effective diagnostic algorithms including clinical probability assessment and D-dimer measurement may be employed followup by compression ultrasonography for suspected DVT patients and multidetector computed tomography angiography for suspected PE patients. There are pharmacological and mechanical interventions to manage and prevent VTE. The pharmacological approaches mainly target pathways in coagulation cascade nonspecifically: conventional anticoagulants or specifically: new generation of anticoagulants. Excess bleeding is one of the major risk factors for pharmacological interventions. Hence, nonpharmacological or mechanical approaches such as inferior vena cava filters, graduated compression stockings, and intermittent pneumatic compression devices in combination with pharmacological interventions or alone may be a good approach to manage VTE.
Clinical guidelines for the prevention, diagnosis and treatment of venous thromboembolism in sport
Apunts. Medicina De L'esport, 2015
The term venous thromboembolism refers to various pathological processes among which deep vein thrombosis, pulmonary embolism, chronic thromboembolic pulmonary hypertension and the thrombotic syndrome. The importance in sports activities is that it is a pathology that requires a long recovery period from 3 to 6 months, and a delayed or unsuccessful diagnosis can cause a more serious illness or even a fatal outcome. Its prevalence in the field of sport is difficult to establish, but empirically it seems to be similar to that of the individual who does not practice sport. However, the field of sport and its environment offers clinical risk conditions to be taken into account, bruising on the vascular bed, rest, travel, dehydration, misguided massage therapy, certain medications or a genetic predisposition, may be factors that precipitate their presence. This guide updates the process, explains the diagnostic protocol and provides prevention guidelines and general treatments, also appl...
Deep Venous Thrombosis and Venous Thromboembolism Prophylaxis
Surgical Clinics of North America, 2015
Venous thromboembolism (VTE), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), remains an all too familiar risk for surgical patients, occurring in up to 25% of those hospitalized. 1 These patients are a unique population who possess all 3 components of Virchow triad (stasis, hypercoagulability, and endothelial injury), completing the triad known to be the cause of thrombus formation. Despite validated guidelines, the problem is frequently left inappropriately addressed, leaving patients at risk for a process that can lead to significant morbidity and mortality. Fifty percent of all DVTs are asymptomatic, but approximately 30% will have additional complications. 2 For some patients, a DVT is a transient episode (ie, the symptoms resolve once the disease is successfully treated). For others, it can lead to a PE, which occurs in more than one-third of patients with DVT. 1,2 PE causes sudden death in up to 34% of patients, 3 particularly when one or more of the larger pulmonary arteries are completely blocked by clot. Most of those who survive do not have any lasting effects; however, if the embolus in the lung fails to completely dissolve, chronic pulmonary Disclosure statement: The authors have nothing to disclose.