Diagnosis of deep vein thrombosis,and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014

The requirement for a safe diagnostic strategy of deep vein thrombosis(DVT) should be based on an overall objective post incidence of venous thromboembolism(VTE) of less than 1% during 3 mo fol low-up. Compression ultrasonography(CUS) of the leg veins has a negative predictive value(NPV) of 97%-98% indicating the need of repeated CUS testing within one week. A negative ELISA VIDAS safely excludes DVT and VTE with a NPV between 99% and 100% at a low clinical score of zero. The combination of low clinical score and a less sensitive D-dimer test(Simplify) is not sensitive enough to exclude DVT and VTE in routine daily practice. From prospective clinical research studies it may be concluded that complete recanalization within 3-6 mo and no reflux is associated with a low or no risk of PTS obviating the need of MECS 6 mo after DVT. Partial and complete recanalization after 6 to more than 12 mo is usually complicated by reflux due to valve destruction and symptomatic PTS. Reflux seems to be a main determinant for PTS and DVT recurrence, the latter as a main contributing factor in worsening PTS. This hypothesis is supported by the relation between the persistent residual vein thrombosis(RVT = partial recanalization) and the risk of VTE recurrence in prospective studies. Absence of RVT at 3 mo postDVT and no reflux is predicted to be associated with no recurrence of DVT(1.2%) during follow-up obviating the need of wearing medical elastic stockings and anticoagulation at 6 mo post-DVT. The presence or absence of RVT but with reflux at or after 6 mo postDVT is associated with both symptomatic PTS and an increased risk of VTE recurrence in about one third in the post-DVT period after regular discontinuation of anticoagulant treatment. To test this hypothesis we designed a prospective DVT and postthrombotic syndrome(PTS) Bridging the Gap Study by addressing at least four unanswered questions in the treatment ofDVT and PTS.Which DVT patient has a clear indication for long-term compression stocking therapy to prevent PTS after the initial anticoagulant treatment in the acute phase of DVT?Is 6 mo the appropriate point in time to determine candidates at risk to develop DVT recurrence and PTS?Which high risk symptomatic PTS patients need extended anticoagulant treatment?

Venous and arterial thromboembolism in patients with inflammatory bowel diseases

The risk of thromboembolism(TE)is increased in patients with inflammatory bowel disease(IBD),mainly due to an increased risk of venous TE(VTE).The risk of arterial TE(ATE)is less pronounced,but an increased risk of cardiovascular diseases needs to be addressed in IBD patients.IBD predisposes to arterial and venous thrombosis through similar prothrombotic mechanisms,including triggering activation of coagulation,in part mediated by impairment of the intestinal barrier and released bacterial components.VTE in IBD has clinical specificities,i.e.,an earlier first episode in life,high rates during both active and remission stages,higher recurrence rates,and poor prognosis.The increased likelihood of VTE in IBD patients may be related to surgery,the use of medications such as corticosteroids or tofacitinib,whereas infliximab is antithrombotic.Long-term complications of VTE can include post-thrombotic syndrome and high recurrence rate during post-hospital discharge.A global clot lysis assay may be useful in identifying patients with IBD who are at risk for TE.Many VTEs occur in IBD outpatients;therefore,outpatient prophylaxis in high-risk patients is recommended.It is crucial to continue focusing on prevention and adequate treatment of VTE in patients with IBD.

Current Status and Prospect of Stent Placement for May-Thurner Syndrome

Stent implantation has been proven to be safe and has become the first-line intervention for May-Thumer syndrome(MTS),with satisfactory mid-term patency rates and clinical outcomes.Recent research has demonstrated that catheter-directed thrombolysis is the preferred strategy when MTS is combined with deep vein thrombosis after self-expanding stent placement.However,the stent used for the venous system was developed based on the experience obtained in the treatment of arterial disease.Consequently,relatively common corresponding complications may come along later,which include stent displacement,deformation,and obstruction.Different measures such as adopting a stent with a larger diameter,improving stent flexibility,and increasing stent strength have been employed in order to prevent these complications.The ideal venous stent is presently being evaluated and will be introduced in detail in this review.

Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis

BACKGROUND Acute lower extremity deep venous thrombosis(LEDVT)is a common vascular emergency with significant morbidity risks,including post-thrombotic syndrome(PTS)and pulmonary embolism.Traditional treatments like catheter-directed thrombolysis(CDT)often result in variable success rates and complications.AIM To investigate the therapeutic efficacy of percutaneous mechanical thrombus removal in acute LEDVT.METHODS A retrospective analysis was performed to examine 58 hospitalised patients with acute LEDVT between August 2019 and August 2022.The patients were categorised into the percutaneous mechanical thrombectomy(PMT)group(n=24)and CDT group(n=32).The follow-up,safety and treatment outcomes were compared between the two groups.The main observational indexes were venous patency score,thrombus removal effect,complications,hospitalisation duration and PTS.RESULTS The venous patency score was 9.04±1.40 in the PMT group and 8.81±1.60 in the CDT group,and the thrombus clearance rate was 100%in both groups.The complication rate was 8.33%in the PMT group and 34.84%in the CDT group,and the difference was statistically significant(P<0.05).The average hospitalisation duration was 6.54±2.48 days in the PMT group and 8.14±3.56 days in the CDT group.The incidence of PTS was lower in the PMT group than in the CDT group;however,the difference was not statistically significant(P<0.05).CONCLUSION Compared with CDT,treatment of LEDVT via PMT was associated with a better thrombus clearance rate,clinical therapeutic effect and PTS prevention function,but the difference was not statistically significant.Moreover,PMT was associated with a reduced urokinase dosage,shortened hospitalisation duration and reduced incidence of complications,such as infections and small haemorrhages.These results indicate that PMT has substantial beneficial effects in the treatment of LEDVT.