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Descriptive Data of Patients with Venous Thromboembolism

Year 2013, Volume: 38 Issue: 4, 610 - 616, 01.12.2013
https://doi.org/10.17826/cutf.55226

Abstract

Purpose: This study was designed for collecting descriptive data about diagnosis and treatment of patients diagnosed with venous thromboembolism (VTE) in an university hospital and for reflecting approach to VTE in such a reference hospital in this way. Material and Methods: We evaluated archive records of patients disgnosed with deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) between 2000 an 2005. Age average of patients was advanced and most of them were women. They had DVT, PTE, DVT and PTE respectively. Most common diagnostic method used for PTE was computed thomogrphy (CT), for DVT was ultrasonography (USG). VTE was diagnosed most frequently in emergency services and policlinics. Most common chronic risk factors for VTE were cancer, heart failure/romathismal cardiac disease, hyperlipidemia/atherosclerosis and obesity. Risk factors spesific to the attacks (or temporary) were immobilization, surgery, pregnancy, taking oral contraseptive drugs and trauma. Results: In patients investigated for hemostatic risk factors, Factor V Leiden, Prothrombin 20210 A , and MTHFR mutations were found respectively. Symptoms and findings of patients admitted with PTE were dyspnea-tachipnea, tachycardia, palpitation, pleural pain, caugh, fever, anginal pain, hemopthysis, diaphoresis and wheezing . Echocardiography gave positive results for the most of PTE cases. D-dimer test was found high sensitive. Treatments during accute attacks were low moleculer weight heparin (LMWH), standart heparin, thrombolytic therapy, surgery, aspirine and vena cava inferior filter placement. Acute term complications were death, bleeding and heparin induced thrombocytopenia. Conclusion: This retrospective study reflects the approach of VTE diagnosis and treatment in a reference hospital and it may guide for prospective studies.

References

  • Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998;158:585-593.
  • Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151:933–938.
  • Kniffin WD Jr, Baron JA, Barrett J, et al. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med. 1994;154:861–866.
  • Nordstrom M, Lindblad B, Bergqvist D, et al. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med. 1992;232:155–160.
  • Turpie AG, Chin BS, and Lip GY. Venous thromboembolism: pathophysiology, clinical features, and prevention. BMJ. 2002 October 19; 325(7369): 887–90.
  • Fedullo PF, Tapson VF. The Evaluation of Suspected Pulmonary Embolism. N Engl J Med 2003;349(13):1247-56.
  • Nordstrom M, Lindblad B, Bergqvist D, et al. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med. 1992;232:155–60.
  • Oger E. Incidence of venous thromboembolism: a community-based study in western France. Thromb Haemost 2000;83:657-60.
  • Kyrle PA, Minar E, Bialonczyk C, Hirschl M, Weltermann A, Eichinger S. The Risk of Recurrent Venous Thromboembolism in Men and Women. N Engl J Med. 2004;350: 2558-63.
  • White RH. The Epidemiology of Venous Thromboembolism. Circulation. 2003;107: 4-8.
  • Murin S, Romano PS, White RH. Comparison of outcomes after hospitalization for deep venous thrombosis or pulmonary embolism. ThrombHaemost. 2002; 88:407–14.
  • Douketis JD, Kearon C, Bates S, et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA. 1998; 279:458–62.
  • Fimognari FL, Repetto L, Moro L, Gianni W and Incalzi RA. Age, cancer and the risk of venous thromboembolism. Crit Rev Oncol Hematol. 2005; 55:207-12.
  • Haas S. Venous thromboembolism in medical patients--the scope of the problem. Semin Thromb Hemost. 2003 ;29 1:17-21.
  • Gurgey A, Haznedaroglu IC, Egesel T, Buyukasik Y, Ozcebe OI, Sayinalp N, Dundar SV, Bayraktar Y. Two common genetic thrombotic risk factors: factor V Leiden and prothrombin G20210A in adult Turkish patients with thrombosis. Am J Hematol. 2001; 67:107-11.
  • Worsley DF, Alavi A. Comprehensive analysis of the results of the PIOPED Study. Prospective Investigation of Pulmonary Embolism Diagnosis Study. J Nucl Med. 1995 Dec; 36:2380-7.
  • Bova C, Greco F, Misuraca G, Serafini O, Crocco F, Greco A, Noto A. Diagnostic utility of echocardiography in patients with suspected pulmonary embolism. Am J Emerg Med. 2003;21:180-3.
  • Miniati M, Monti S, Pratali L, Di Ricco G, Marini C, Formichi B, Prediletto R, Michelassi C, Di Lorenzo M, Tonelli L, Pistolesi M. Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: results of a prospective study in unselected patients. Am J Med. 2001; 110: 528-35.
  • Jackson RE, Rudoni RR, Hauser AM, Pascual RG, Hussey MEP retrospective evaluation of twodimensional transthoracic echocardiography in emergency department patients with suspected pulmonary embolism. Acad Emerg Med. 2000; 7: 994Vermeer HJ, Ypma P, van Strijen MJ, Muradin AA, Hudig F, Jansen RW, Wijermans PW and Gerrits WB.
  • Exclusion of venous thromboembolism: evaluation of D-Dimer PLUS for the quantitative determination of D-dimer. Thrombosis research. 2005; 115:381-6. 21) Kruip MJ, Slob MJ, Schijen JH, van der Heul C, Buller HR. Use of a clinical decision rule in combination with D-dimer concentration in diagnostic workup of patients with suspected pulmonary embolism: a prospective management study.Arch Intern Med. 2002; 162:1631-5.
  • Elias A, Cazanave A, Elias M, Chabbert V, Juchet H, Paradis H, Carriere P, Nguyen F, Didier A, Galinier M, Colin C, Lauque D, Joffre F, Rousseau H. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. 2004; 116:352-3.
  • Schutgens RE, Ackermark P, Haas FJ, Nieuwenhuis HK, Peltenburg HG, Pijlman AH, Pruijm M, Oltmans R, Kelder JC, Biesma DH. Combination of a normal D-dimer concentration and a non high pretest clinical probability score is a safe strategy to exclude deep venous thrombosis.Circulation. 2003;107:593-7.
  • Tick LW, Ton E, van Voorthuizen T, Hovens MM, Leeuwenburgh I. Practical diagnostic management of patients with clinically suspected deep vein thrombosis by clinical probability test, compression ultrasonography, and D-dimer test. Am J Med. 2002; 113:630-5.
  • Palareti G, Legnani C, Cosmi B, Guazzaloca G, Pancani C, Coccheri S.Risk of venous thromboembolism recurrence: high negative predictive value of D-dimer performed after oral anticoagulation is stopped. Thromb Haemost. 2002; 87:7Eichinger S, Minar E, Bialonczyk C, Hirschl M, Quehenberger P, Schneider B, Weltermann A, Wagner O, Kyrle PA. D-dimer levels and risk of recurrent venous thromboembolism.Jama. 2003; 290:1071-4.
  • Kakkar VV , Gebska M, Kadziola Z, Saba N, Carrasco P. Low-molecular-weight heparin in the acute and long-term treatment of deep vein thrombosis.Thromb Haemost. 2003; 89:674-80.
  • Leizorovicz A, Simonneau G, Decousus H, Boissel JP. Comparison of efficacy and safety of low molecular weight heparins and unfractionated heparin in initial treatment of deep venous thrombosis: a meta-analysis. BMJ. 1994; 309:29930
  • Fedullo PF, Auger WR, Kerr KM, et al. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2001; 345:1465.
  • Jamieson SW, Kapelanski DP. Pulmonary endarterectomy. Curr Probl Surg. 2000; 37:165.
  • Yazışma Adresi / Address for Correspondence: Dr. Gül İlhan Hatay Antakya Government Hospital gullhan2002@yahoo.com geliş tarihi/received :03.03.2013 kabul tarihi/accepted:29.03.2013

Venöz Tromboemboli Tanısı Konulan Hastaların Tanımlayıcı Bulguları

Year 2013, Volume: 38 Issue: 4, 610 - 616, 01.12.2013
https://doi.org/10.17826/cutf.55226

Abstract

Amaç: Bu çalışma; üniversite hastanesinde venöz tromboembolizmi (VTE) teşhisi ve tedavisi hakkında açıklayıcı veri toplanmasını ve böylece bir referans hastanesindeki VTE yaklaşımını yansıtmak için planlanmıştır. Materyal ve Metod: Çalışmamızda derin ven trombozu (DVT) ve pulmoner tromboembolizmi (PTE) tanısı konulan hastaların arşiv kayıtlarını değerlendirdik. Hastaların birçoğunun yaşı ileri ve cinsiyeti kadındı. PTE için en sık kullanılan tanı yöntemi; bilgisayarlı tomografi (CT), DVT için ise ultrasondu. VTE acil servislerde ve polikliniklerde en yaygın tanısı konulan hastalıktır. Hastalara sırasıyla DVT, PTE, DVT ve PTE uygulandı. VTE için en sık rastlanan kronik risk faktörleri kanser, kalp yetmezliği/romatizmal kalp rahatsızlığı, hiperlipidemi/ateroskleroz ve obesitedir. Ataklara özgü risk faktörleri hareketsizlik, ameliyat, gebelik, oral kontraseptif ilaç ve travmaydı. Bulgular: Hemostatik risk faktörlerinin araştırıldığı hastalarda; sırasıyla faktör V Leiden, protrombin 20210 ve MTHFR mutasyonları bulundu. PTE"li hastalarda bulunan bulgular ve semptomlar; dispne-takipne, taşikardi, palpitasyon, göğüs ağrısı, öksürük, ateş, boğaz ağrısı, hemoptiz, diyaforez ve hırıltılı solunumdu (vizing). Elektrokardiyografi, PTE vakalarının çoğu için olumlu sonuçlar verdi. D-Dimer testi ise yüksek oranda duyarlı bulunmuştur. Akut ataklar sırasında uygulanan tedaviler; düşük molekül ağırlıklı heparin (LMWH), standart heparin, trombolitik tedavi, ameliyat, aspirin ve inferior vena kava filtresi yerleştirilmesidir.Akut dönem komplikasyonları ölüm, kanama ve heparin kaynaklı trombositopeniydi. Sonuç: Bu retrospektif çalışma bir referans hastanesindeki VTE tanı ve tedavi yaklaşımlarını yansıtmakta olup ileriye dönük çalışmalar için yol gösterici olabilir.

References

  • Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998;158:585-593.
  • Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151:933–938.
  • Kniffin WD Jr, Baron JA, Barrett J, et al. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med. 1994;154:861–866.
  • Nordstrom M, Lindblad B, Bergqvist D, et al. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med. 1992;232:155–160.
  • Turpie AG, Chin BS, and Lip GY. Venous thromboembolism: pathophysiology, clinical features, and prevention. BMJ. 2002 October 19; 325(7369): 887–90.
  • Fedullo PF, Tapson VF. The Evaluation of Suspected Pulmonary Embolism. N Engl J Med 2003;349(13):1247-56.
  • Nordstrom M, Lindblad B, Bergqvist D, et al. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med. 1992;232:155–60.
  • Oger E. Incidence of venous thromboembolism: a community-based study in western France. Thromb Haemost 2000;83:657-60.
  • Kyrle PA, Minar E, Bialonczyk C, Hirschl M, Weltermann A, Eichinger S. The Risk of Recurrent Venous Thromboembolism in Men and Women. N Engl J Med. 2004;350: 2558-63.
  • White RH. The Epidemiology of Venous Thromboembolism. Circulation. 2003;107: 4-8.
  • Murin S, Romano PS, White RH. Comparison of outcomes after hospitalization for deep venous thrombosis or pulmonary embolism. ThrombHaemost. 2002; 88:407–14.
  • Douketis JD, Kearon C, Bates S, et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA. 1998; 279:458–62.
  • Fimognari FL, Repetto L, Moro L, Gianni W and Incalzi RA. Age, cancer and the risk of venous thromboembolism. Crit Rev Oncol Hematol. 2005; 55:207-12.
  • Haas S. Venous thromboembolism in medical patients--the scope of the problem. Semin Thromb Hemost. 2003 ;29 1:17-21.
  • Gurgey A, Haznedaroglu IC, Egesel T, Buyukasik Y, Ozcebe OI, Sayinalp N, Dundar SV, Bayraktar Y. Two common genetic thrombotic risk factors: factor V Leiden and prothrombin G20210A in adult Turkish patients with thrombosis. Am J Hematol. 2001; 67:107-11.
  • Worsley DF, Alavi A. Comprehensive analysis of the results of the PIOPED Study. Prospective Investigation of Pulmonary Embolism Diagnosis Study. J Nucl Med. 1995 Dec; 36:2380-7.
  • Bova C, Greco F, Misuraca G, Serafini O, Crocco F, Greco A, Noto A. Diagnostic utility of echocardiography in patients with suspected pulmonary embolism. Am J Emerg Med. 2003;21:180-3.
  • Miniati M, Monti S, Pratali L, Di Ricco G, Marini C, Formichi B, Prediletto R, Michelassi C, Di Lorenzo M, Tonelli L, Pistolesi M. Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: results of a prospective study in unselected patients. Am J Med. 2001; 110: 528-35.
  • Jackson RE, Rudoni RR, Hauser AM, Pascual RG, Hussey MEP retrospective evaluation of twodimensional transthoracic echocardiography in emergency department patients with suspected pulmonary embolism. Acad Emerg Med. 2000; 7: 994Vermeer HJ, Ypma P, van Strijen MJ, Muradin AA, Hudig F, Jansen RW, Wijermans PW and Gerrits WB.
  • Exclusion of venous thromboembolism: evaluation of D-Dimer PLUS for the quantitative determination of D-dimer. Thrombosis research. 2005; 115:381-6. 21) Kruip MJ, Slob MJ, Schijen JH, van der Heul C, Buller HR. Use of a clinical decision rule in combination with D-dimer concentration in diagnostic workup of patients with suspected pulmonary embolism: a prospective management study.Arch Intern Med. 2002; 162:1631-5.
  • Elias A, Cazanave A, Elias M, Chabbert V, Juchet H, Paradis H, Carriere P, Nguyen F, Didier A, Galinier M, Colin C, Lauque D, Joffre F, Rousseau H. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. 2004; 116:352-3.
  • Schutgens RE, Ackermark P, Haas FJ, Nieuwenhuis HK, Peltenburg HG, Pijlman AH, Pruijm M, Oltmans R, Kelder JC, Biesma DH. Combination of a normal D-dimer concentration and a non high pretest clinical probability score is a safe strategy to exclude deep venous thrombosis.Circulation. 2003;107:593-7.
  • Tick LW, Ton E, van Voorthuizen T, Hovens MM, Leeuwenburgh I. Practical diagnostic management of patients with clinically suspected deep vein thrombosis by clinical probability test, compression ultrasonography, and D-dimer test. Am J Med. 2002; 113:630-5.
  • Palareti G, Legnani C, Cosmi B, Guazzaloca G, Pancani C, Coccheri S.Risk of venous thromboembolism recurrence: high negative predictive value of D-dimer performed after oral anticoagulation is stopped. Thromb Haemost. 2002; 87:7Eichinger S, Minar E, Bialonczyk C, Hirschl M, Quehenberger P, Schneider B, Weltermann A, Wagner O, Kyrle PA. D-dimer levels and risk of recurrent venous thromboembolism.Jama. 2003; 290:1071-4.
  • Kakkar VV , Gebska M, Kadziola Z, Saba N, Carrasco P. Low-molecular-weight heparin in the acute and long-term treatment of deep vein thrombosis.Thromb Haemost. 2003; 89:674-80.
  • Leizorovicz A, Simonneau G, Decousus H, Boissel JP. Comparison of efficacy and safety of low molecular weight heparins and unfractionated heparin in initial treatment of deep venous thrombosis: a meta-analysis. BMJ. 1994; 309:29930
  • Fedullo PF, Auger WR, Kerr KM, et al. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2001; 345:1465.
  • Jamieson SW, Kapelanski DP. Pulmonary endarterectomy. Curr Probl Surg. 2000; 37:165.
  • Yazışma Adresi / Address for Correspondence: Dr. Gül İlhan Hatay Antakya Government Hospital gullhan2002@yahoo.com geliş tarihi/received :03.03.2013 kabul tarihi/accepted:29.03.2013
There are 29 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Gül İlhan This is me

Publication Date December 1, 2013
Published in Issue Year 2013 Volume: 38 Issue: 4

Cite

MLA İlhan, Gül. “Venöz Tromboemboli Tanısı Konulan Hastaların Tanımlayıcı Bulguları”. Cukurova Medical Journal, vol. 38, no. 4, 2013, pp. 610-6, doi:10.17826/cutf.55226.