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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2001 June;20(2):141-7

lingua: Inglese

An audit of the clinical and sub-clinical changes in the first year following an acute deep vein thrombosis

O’Shaughnessy A. M. *, ** , Fitzgerald D. E. *

From ­the * Vascular Medicine Unit, James Connolly Memorial Hospital, Blanchardstown, Dublin,
** Department of Anatomy, Trinity College, Dublin, Ireland.


Background. An aud­it of 100 prox­i­mal (­above ­knee) ­deep ­vein throm­bos­es (­DVT) ­was car­ried ­out to doc­u­ment ­the dynam­ic stat­us of ­the con­di­tion dur­ing ­the ­first ­year.
Methods. Duplex ultra­sound ­was ­used to diag­nose ­the pres­ence of an ­acute deep vein thrombosis in a con­sec­u­tive ­series of ­patients. Follow-up bilat­er­al ultra­sound ­scans ­were per­formed at ­one ­week, ­one ­month, ­six ­months ­and at ­one ­year ­and ­clot retrac­tion, ­lysis or exten­sion ­were record­ed. The ­patients’ treat­ment ­regime ­and symp­toms ­were ­also record­ed at ­each fol­low-up exam­ina­tion.
Results. There ­were 100 prox­i­mal DVT’s ­from 89 ­patients (11 bilat­er­al throm­bos­es). The ­patient pop­u­la­tion includ­ed ­those ­with a pre­vi­ous his­to­ry of ­DVT or in ­the ­end stag­es of a ­major ill­ness ­and ­those ­with rever­sible ­risk fac­tors. The mor­tal­ity ­rate ­over ­the ­one-­year peri­od ­was 14%, ­most of ­the ­deaths occur­ring in ­the ­first ­month. The major­ity of ­deaths ­occurred as a ­result of an under­ly­ing pri­mary dis­ease (e.g. can­cer) ­and 3% ­died ­from a pul­mo­nary embo­lism. All ­patients ­were treat­ed initial­ly ­with ­either intra­ve­nous (IV) hep­ar­in or sub­cu­ta­ne­ous ­low molec­u­lar ­weight (­SCLMW) hep­ar­in. Following hep­ar­in ­all ­patients ­were treat­ed ­with war­far­in. The dura­tion of anti­co­ag­u­lant ther­a­py var­ied ­with ­most phy­si­cians treat­ing ­the ­patient ­for ­six ­months. Symptomatic ­and asymp­to­mat­ic ­events (pul­mo­nary embo­li, exten­sion of throm­bi, ­new DVT’s) ­were record­ed in ­the fol­low-up peri­od espe­cial­ly in ­the ­initial ­and ­late ­phase.
Conclusions. The aud­it con­clud­ed ­that ­the diag­no­sis ­and treat­ment of ­DVT con­tin­ues to be a ­major clin­i­cal prob­lem ­with uncer­tain­ty as to ­the ­type ­and ­length of treat­ment ­required. The mobil­ity of ­the ­patient ­was ­not con­sid­ered in ­the ­choice of ­initial hep­ar­in treat­ment. Anticoagulants ­were gen­er­al­ly con­tin­ued ­for a peri­od of up to ­six ­months regard­less of ­the ­patient’s ­risk fac­tors. Little con­sid­er­a­tion ­was giv­en to asymp­to­mat­ic ­events ­with phy­si­cians ­still depend­ing on unre­li­able clin­i­cal symp­toms to deter­mine if recur­renc­es ­had ­occurred. Generally, no con­sid­er­a­tion ­was giv­en to ­the ­long-­term con­se­quenc­es of a ­post-throm­bot­ic ­limb at ­the ­initial ­stage of treat­ment of a ­DVT.

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