Preventive value of systematic nursing for lower limb deep venous thrombosis after obstetrics and gynaecology surgery.

Objective To investigate the risk factors and preventive measures of deep venous thrombosis (DVT) in lower limbs after hip arthroplasty. Methods 78 patients undertaking hip replacement at our hospital from June, 2014 to June, 2016 were collected and were divided into a thrombosis group and a no thrombosis group according to the presence of postoperative lower extremity DVT. The gender, age, coronary heart disease, hypertension, obesity, body mass index, operation time, time in bed over 7 days, etc. affect DVT in lower limbs were compared between these two groups. Single and multiple factors logistic regression analysis were used to analyze the risk factors of lower extremity DVT after hip replacement. Results Univariate analysis showed that there statistical differences in over 60 years old, hypertension, operation time, time in bed over 7 days, etc. between these two groups (all P<0.05). Multivariate logistic regression analysis showed that over 60 years old, hypertension, and time in bed over 7 days were important risk factors for DVT in lower limbs after hip replacement. Conclusions Over 60 years old, hypertension, and time in bed over 7 days are important risk factors for DVT in lower limbs after hip replacement. Preventive measures should be taken early to prevent the occurrence of DVT. Key words: Hip replacement; Deep venous thrombosis; Risk factors; Countermeasures

Lower limb deep venous thrombosis (DVT), and its sequelae (lower limb chronic venous insufficiency and pulmonary embolism) are now well acknowledged as major haematological problems in the world, for which appropriate and accurate means of diagnosis is necessary. Developments in ultrasound have made it the imaging modality of choice in the diagnosis of lower limb DVT. To determine the sonographic pattern, and identify the risk factors of lower limb DVT. Cross sectional, descriptive study carried out between April 2002 and March 2003. Mulago Hospital, Uganda. Eighty six consecutive patients (92 limbs), with clinically suspected DVT, were studied by duplex sonography after a thorough risk factor evaluation. Out of a total of 86 patients clinically suspected to have lower limb DVT, 38 (44.2%) were found to have DVT after sonography. The gender incidence was similar. The left limb was affected in 60% of cases and the right in 40%. Bilateral DVT was noted in two patients. Most of the patients had acute and extensive DVT. Duplex ultrasonography is a very useful modality for assessing lower limb DVT, even in a low resource country like Uganda. It demonstrates the wealth of information obtained from sonography.

BackgroundDeep vein thrombosis (DVT) is a common health problem. Accurate diagnosis of DVT is essential to avoid potentially fatal acute consequences of pulmonary embolism.AimThe study aims to assess deep venous thrombosis (DVT) of the lower limbs and to analyze the related risk factors.MethodsThis is a retrospective study including 60 patients who were examined using Triplex Doppler imaging. The patients were referred to the imaging departments with symptoms of lower limb DVT. The risk of DVT was expressed as an odds ratio (OR) with 95% confidence interval. Multiple logistic regression analysis was used to detect the independent risk factors. P value <0.05 was considered a significant statistic.ResultsAmong the Saudi patients in Najran, acute DVT was more prevalent than chronic one (56.7% vs 38.3%), while subacute is less frequent (5%). DVTs are more prevalent in females than males (60% vs 40%) and most commonly affect patients older than 40. DVTs affect the left lower limb veins more than the right limb (75% vs 15%) and are less frequent on both sides (10%). The left popliteal vein (PV) and left common femoral vein (CFV) were the most common sites for acute DVTs. Binary logistic analysis revealed the independent risk factors for developing lower extremity DVT; malignancy (OR = 2.84, 95% CI = 0.518–15.513), surgery (OR = 2.66, 95% CI = 0.411–17.281), trauma (OR = 2.30, 95% CI = 0.452–11.658), and diabetes and hypertension (OR = 1.53, 95% CI = 0.335–6.969).ConclusionAcute lower limb DVT was more prevalent than chronic one. Malignancy, surgery, trauma, diabetes mellitus, and hypertension were the most common risk factors for lower limb DVTs. Left popliteal and left common femoral veins were the most common sites of acute DVTs.

Objective To investigate the clinical value of thrombolysis via popliteal venous catheterguided by ultrasound on lower limb deep venous thrombosis (DVT).Methods From April 2007 to October 2011,the data of 109 cases of lower limb deep venous thrombosis in our hospital were retrospectively analyzed.All the cases were performed with thrombolysis by popliteal venous catheter guided by ultrasound combined with continuous injection of the thrombolytic drugs through catheter micro-pump,and anticoagulant therapy were undergone.Results Thrombolysis catheter was successfully inserted in all cases,66 cases were cured,markedly effective in 32 cases,effective in 11 cases,and total technical success rate was 100％.Conclusions Thrombolysis via popliteal venous catheter guided by ultrasound for lower limb deep venous thrombosis is effective with higher cure rate,shorter treatment time,lower amount of urokinase,less complications,and is worthy of clinical application. Key words: Ultrasound-guided; Catheter thrombolysis; Popliteal vein; Deep venous thrombosis

Objective To investigate the implication of C-reactive protein in development and prognosis of acute lower limb deep venous thrombosis (DVT) complicated by malignant tumor.Methods 34patients with acute lower limb DVT complicated by malignant tumor (observation group),34 patients with acute lower limb DVT complicated by operation or wound (case control group) and 34 normal volunteers (normal control group) were included in this study.The observation group and case control group were treated with conventional therapy such as thrombolysis and anticoagulation.The serum concentrations of CRP before treatment and 14 days after treatment were detected. Recanalization of lower limb DVT and therapeutic efficacy were compared between observation group and case control group.Results The serum concentrations of CRP in observation group before treatment were significantly higher than those in case control group and normal control group [(47.72±29.88) mg/L vs (30.04±15.84) mg/L and (6.19±2.99) mg/L,F =38.444,P ＜ 0.01].At the 14th day of post-treatment,the serum CRP concentrations in observation group and case control group were significantly lower than those before treatment (P ＜0.05).At the 14th day of post-treatment,the CRP concentrations of observation group and case control groups were significantly decreased,although those of observation group were still significantly higher than those of case control group and normal control [(32.77±19.68) mg/L vs (7.76±7.52) mg/L and (6.19±2.99) mg/L,F =50.087,P ＜ 0.01].However,there was no significant difference between case control group and normal control group on the 14th day of post-treatment (F =1.277,P =0.263).The recanalization rate of observation group at the 14th day of post-treatruent were significantly lower than those in case control group (x2 =7.731,P =0.021).The therapeutic effect rate of observation group at the 14th day of post-treatment were also significantly lower than those in case control group (x2 =6.969,P =0.031).Conclusion CRP may play important roles in occurrence,development and therapeutic effect of acute lower limb DVT complicated by malignant tumor. Key words: C-reactive protein; Venous thrombosis; Treatment outcome

To study the pathogenetic mechanism of lower limb deep venous thrombosis (DVT). Thrombosis test in vitro of 206 cases with lower limb DVT was measured. All of them were treated by integrated traditional Chinese and Western medicine (TCM-WM). The indexes of thrombosis test in vitro of patients were much higher than those of normal subjects (P < 0.001). The relevent indexes were different in types distribution according to differentiation of symptoms and signs (P < 0.01-0.001) and between before and after treatment (P < 0.001). It showed that hypercoagulability of blood occurred even if after the occurence of DVT. Changes of indexes might be objective parameters for Syndrome Differentiation in TCM. The indexes became lower when state of illness was improving. The therapy of TCM-WM has good efficacy for DVT.

Objectives:To determine the prevalence of May-Thurner syndrome (MTS) in left lower limb deep venous thrombosis (DVT) cases and to analyze the outcome of endovascular intervention in these patients.Methods:A record-based descriptive study was carried out in Radiology Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia, including patients who underwent lower limb duplex ultrasounds between January 2015-2021. Patients with bilateral DVTs, known pelvic masses, and pelvic surgeries were excluded. All patients positive for DVTs were identified and further imaging was reviewed. Left common iliac vein compression of 50% or more on computed tomography (CT) was considered positive for MTS. Endovascular interventions (venoplasty alone or with stenting) were evaluated and success recorded by observing patency of vein on follow-up imaging or improvement of symptoms on follow-up visits.Results:Of 182 patients with left lower limb duplex studies, 51 patients were positive for DVTs. A total of 37 patients had CTs and 21 patients had MTS (17 females, 3 males). A total of 15 patients underwent endovascular interventions, 2 patients had venoplasties alone (one successful) and 13 patients had venoplasties with stenting (10 successful).Conclusion:Patients with MTS as cause of DVT may benefit from early endovascular intervention.

The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital. This is a retrospective review. The setting is three freestanding inpatient rehabilitation hospitals operating as one system. The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer. A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital. Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis. A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness. The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.

背景与目的分析胸外科术后重症患者住重症加强护理病房（intensive care unit, ICU）期间的下肢深静脉血栓（deep venous thrombosis, DVT）发生率与凝血指标。方法回顾性分析2016年7月-2018年6月接受物理预防血栓的胸外科术后重症患者，将床旁下肢静脉超声、血常规、凝血四项、血栓弹力图等结果完善的病例纳入研究，对发生血栓人群的一般信息、病种、手术方式、凝血指标等进行分析。结果共纳入患者50例，年龄22岁-80岁，男34例，女16例。共有11例患者出现小腿深静脉血栓（22.0%），男性发生术后血栓的比例为29.4%（10/34），女性为6.3%（1/16）。恶性肿瘤的DVT发生率为23.5%（8/34），非恶性肿瘤的发生率为18.6%（3/16）。比较发生血栓和未发生血栓组的血小板计数、凝血四项、血栓弹力图等，除活化部分凝血活酶时间血栓组较无血栓组显著延长外，余无统计学差异。结论即便在充分物理预防的基础上，胸科术后重症患者下肢深静脉血栓仍为高发，且男性、恶性肿瘤患者多见；术后超声筛查有助于早期发现DVT。

Background The optimal duration of anticoagulant therapy in management of patients with first episode of unprovoked deep venous thrombosis is uncertain. D-dimer test may play a role in the assessment of duration of anticoagulant therapy to decrease the rate of recurrence. Aim To evaluate if D dimer test can be used as predictor to guide the duration of anticoagulation in patients with first unprovoked proximal lower limb deep venous thrombosis. Patients and Methods One hundred patients with a first unprovoked proximal deep-vein thrombosis who completed 3 months of Vitamin K Antagonists (VKAs) and had elevated d dimer test 1 month after discontinuation of anticoagulation were randomly assigned either to resume (group A) or to discontinue treatment (group B). The patients were followed up for 1 year for recurrent venous thromboembolism and treatment complications. Results The mean age of the patients was 49.96±7.88 and 51.78±7.98 years for group A and B respectively. Male to female ratio was nearly similar in both groups 3:2 . The base line D-dimer level was 3.05±0.84 and 3.15±1.00 for group A and B respectively with no statistical significant difference. The mean duration of follow up was 10.6 months for both groups. The recurrence rate was higher in group B (7 cases) compared to group A (1 case) (P value 0.027) and this difference was statistically significant. No major bleeding or pulmonary embolism have been noticed in any patients during follow up. Conclusion Elevated D dimer test 1 month after discontinuation of 3 months anticoagulation, in the absence of recent thrombosis, could be an indicator for resumption of anticoagulant therapy for another 3 months.

We conducted this study to assess the progression or regression of venous thrombi during and after treatment and to search for criteria of embolism risk. We prospectively studied 75 patients with lower limb deep venous thrombosis. We used B-mode sonography for the diagnosis and follow-up of these thrombi. Pulmonary scintigraphy was performed at days 1 and 10. We evaluated the topography, echogenicity, and structure of the thrombus; the location and wall attachment of its head; and the vein diameter. Each venous segment was semiquantitatively scored as follows: 0, no thrombosis; 1, partially obstructive thrombosis; or 2, complete thrombosis. The decreases in the total thrombosis score were 4%, 11%, 51%, 72%, and 84% on days 5, 10, 30, 90, and 365 (1 year), respectively. Pulmonary embolism occurred in 27 patients, of whom 16 were asymptomatic. Thrombi in iliac veins exhibited a slower regression rate than those in calf and femoral veins. Pulmonary embolism occurred in 54% of patients with versus 24% of patients without a floating thrombus head. Sonography is useful for the early detection of thrombus progression and the evaluation of embolism risk, which seems to be greater in patients with a floating thrombus head.

Prevalence and Risk Factors of Asymptomatic Lower Extremity Deep Venous Thrombosis in Asian Neurorehabilitation Admissions in Singapore

Background and objective: Lower limb deep venous thrombosis is a common condition with a recognized morbidity and mortality. Hitherto known as a complication in hospitalized patients, anecdotal media reports and scientific trials have raised the profile of the same condition in association with air travel. Although probably multifactorial in aetiology, venous stasis is considered an important and correctable risk factor in the pathogenesis of deep venous thrombosis. The aim of this study was to assess the effectiveness of exercising the calf muscle blood pump in increasing venous blood flow using a new dynamic alternating inflatable biped device (Lymgym™, Lymgym Ltd, UK) which has been designed to be used by air passengers. Methods: Doppler ultrasound was used to assess peak flow velocity in the superficial femoral vein in 30 lower limbs of 15 healthy volunteers with no history of venous disease. Measurements of peak flow velocity were taken at rest in the seated 'coach position' and during calf muscle pump exercises with the device. Results: Peak blood flow velocity was eight-fold higher ( P &lt; 0.0001, Wilcoxon signed rank test) during exercise with the device than at rest. Conclusions: These results show that use of the dynamic alternating biped device (Lymgym™) effectively reduces venous stasis when used in the seated position as defined by measurements of peak venous blood flow. These results provide the scientific justification for further studies assessing the value of this device in reducing the risk of travel-related thrombosis.

Retroperitoneal schwanoma presenting as deep venous thrombosis

Primary and secondary antiphospholipid syndrome characteristics in an Egyptian cohort