Incidence and characteristics of asymptomatic distal deep vein thrombosis unexpectedly found at admission in an Internal Medicine setting |
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Authors: | Ciuti Gabriele Grifoni Elisa Pavellini Andrea Righi Daniele Livi Riccardo Perfetto Federico Abbate Rosanna Prisco Domenico Pignone Alberto Moggi |
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Institution: | a SOD Medicina Interna ad Orientamento all'Alta Complessità Assistenziale 3, AOU Careggi, Firenze, Italyb SOD Valutazione Cardiologica, AOU Careggi, Firenze, Italyc SOD Malattie Aterotrombotiche, AOU Careggi, Firenze, Italyd SOD Patologia Medica, AOU Careggi, Firenze, Italy |
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Abstract: | IntroductionLower limb deep vein thrombosis (DVT) is the most frequent clinical manifestation of venous thromboembolism (VTE) and can involve proximal or distal veins. Distal DVT (dDVT) is often asymptomatic and data about its incidence and prognosis are scanty, especially in high risk medical inpatients. Therefore, no consensus exists on the value of detecting and treating dDVTs. Aim of study was to evaluate incidence and characteristics of asymptomatic isolated dDVT at admission in an Internal Medicine department.Materials and methodsConsecutive patients hospitalized for acute medical illnesses, in whom VTE was not the admission diagnosis, underwent Doppler Ultrasonography. For all patients with dDVT standard treatment with therapeutic doses of low molecular weight heparin or fondaparinux was proposed. Follow-up visits were scheduled at 1, 6 and 12 weeks.ResultsOne-hundred-fifty-four patients were enrolled. In 4.5% a proximal DVT and in 16.2% an asymptomatic dDVT were found. Female sex, elevated age and renal and electrolyte abnormalities were significantly associated to dDVT (p = 0.014, p = 0.009 and p = 0.046, respectively). Only low degree of mobility (LDM) was independently associated to dDVT OR 7.97 (95%CI 2.42-26.27), p = 0.001)]. A high mortality rate, not for VTE-related causes, was found, especially in the first week, among dDVT patients.ConclusionsWe found a high incidence of clinically silent dDVTs. LDM evaluation could be useful to select patients at high risk in whom to perform a search for dDVT. |
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Keywords: | DVT deep vein thrombosis VTE venous thromboembolism dDVT distal deep vein thrombosis US ultrasonography PE pulmonary embolism LMWH low molecular weight heparin LDM low degree of mobility HDM high degree of mobility NPV negative predictive value |
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