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Objectives: A relationship between endoscopic submucosal dissection (ESD) and deep vein thrombosis has been recognized. We previously reported that a high corrected midazolam dose (total midazolam dose/initial dose of midazolam used to induce sedation) is related to elevated D-dimer levels after ESD. In this study, the effect of compression stockings (CSs) in preventing thrombosis following ESD under sedation was evaluated by measuring D-dimer levels before and after ESD. Methods: The participants were patients who underwent ESD for upper gastrointestinal tumors during the period between April 2018 and October 2022. Patients with pre-ESD D-dimer levels ≥1.6 µg/m and patients with corrected midazolam doses ≤3.0 were excluded. A retrospective investigation of the relationship between CS use and high post-ESD D-dimer levels (difference in D-dimer levels ≥1.0 µg/mL between before and after ESD) was conducted. Results: There were 27 patients in the non-CS group (NCS) and 33 patients in the CS group. The number of patients with high post-ESD D-dimer levels was 13 (48.2%) in the non-CS group and six (18.2%) in the CS group; the number in the CS group was significantly lower (p = 0.024). On logistic regression analysis, a relationship was seen between the wearing of CSs and a lower number of patients with high post-ESD D-dimer levels (odds ratio 0.24, 95% confidence interval 0.08-0.79, p = 0.019). Conclusion: Wearing CSs was related to a lower risk of high post-ESD D-dimer levels. This result suggests that thrombus formation is a cause of elevated D-dimer levels after ESD.

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Background: Pulmonary embolism (PE) is a serious and potentially life-threatening condition that requires prompt diagnosis and treatment. Identifying risk factors and diagnostic markers can aid in the early detection and management of this condition. Methods: This case-control study examined 10,077 patients admitted to Shenzhen Kangning Hospital's psychiatry facility in 2020. Among these, 65 patients were diagnosed with PE, including 50 new cases. After survival sampling for controls and age-and-gender matching, the study included 41 new PE cases and 41 age-and-gender-matched controls. Data on demographics, comorbidities, and medication use were extracted from electronic records. Conditional logistic regression analyses were performed to determine the association between each predictor and PE risk. Additionally, the sensitivity and specificity of the d-dimer diagnostic tool were assessed. Results: In univariable conditional logistic regression, active alcoholism was associated with a higher PE risk (OR=3.675, 95% CI 1.02-13.14, P=0.046). A history of physical restraint (OR=4.33, 95% CI 1.24-15.21, P=0.022) and chemical restraint (OR 4.67, 95% CI 1.34-16.24, p=0.015) also increased PE risk, as did benzodiazepine use (OR=3.33, 95% CI 1.34-8.30, P=0.010). Conversely, psychotropic medication before admission was associated with a lower risk of PE (OR=0.07, 95% CI 0.01-0.59, P=0.013). Stepwise multivariable forward conditional regression identified two subsets of psychiatric patients at higher risk of PE: new psychiatric cases without medication at admission who were chemically restrained, and cases without medication at admission who were started on antipsychotics and benzodiazepines. The d-dimer diagnostic tool, with an optimal threshold of 570 ng/ml determined by the Youden index (J statistic of 0.6098), showed a sensitivity of 73.17% and specificity of 87.80% for detecting PE, with an AUC of 0.833 (95% CI: 0.735-0.906). Conclusion: Our findings suggest that a history of restraint, alcoholism, and the use of antipsychotics and benzodiazepines are important predictors of PE in psychiatric inpatients. Conversely, psychotropic medications at admission may be linked to a lower PE risk. The d-dimer diagnostic tool shows good value for screening PE in psychiatric inpatients. These predictors and diagnostic markers could help clinicians identify high-risk patients and implement appropriate prevention strategies.

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Introduction Current studies suggest that both chemical and mechanical venous thromboembolism (VTE) prophylaxis is underused, which is concerning due to the potential lethality of VTEs. The Caprini risk score is a preoperative VTE risk assessment that determines a patient's risk of enduring a VTE. The objective of this study was to examine postoperative cases of VTE to determine if accurate VTE risk stratification was performed and whether appropriate VTE prophylaxis was administered. Methods A retrospective analysis was conducted on 23 reported cases of VTE that occurred at a Central Florida hospital from April 1, 2021, to March 31, 2022. Relevant demographic and medical information was gathered from each patient chart to calculate an individual Caprini risk score and determine the type of chemical VTE prophylaxis that was received. Results Out of 23 reported cases of VTE in surgical patients, 17 were ultimately determined to have suffered VTE associated with their hospitalization and surgery. Thirteen out of 17 (76%) received appropriate perioperative chemical deep vein thrombosis (DVT) prophylaxis based on the calculated Caprini risk score and corresponding recommendations. Four out of 17 (24%) were determined to have received insufficient perioperative chemical DVT prophylaxis. Conclusion Consistent utilization of a DVT/pulmonary embolism (PE) risk stratification tool, such as the Caprini risk score calculator, is essential in the prevention of postoperative VTE. Hospitals can improve the utilization of such a tool and thereby reduce the number of embolic events by making it more visible and accessible to the overseeing provider in the electronic medical record (EMR).

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Background: Critically ill medical patients face a heightened risk of developing venous thromboembolism. In Thailand, routine thromboprophylaxis is not employed. The incidence of deep vein thrombosis (DVT) in the medical intensive care unit (ICU) has not been elucidated in the Thai population. Objectives: The aims were to evaluate the incidence of DVT and identify associated risk factors in critically ill medical patients. Methods: A single-center, prospective cohort study was conducted from 2019 to 2020. Consecutive patients underwent screening for proximal DVT by duplex ultrasound of both legs. Results: A total of 200 patients were enrolled, with 115 being male (57%). The mean (SD) age was 66.5 (16.4) years. The mean (SD) Acute Physiology and Chronic Health Evaluation II score was 27 (8). The cumulative incidence of DVT over 5 days was 7% (95% CI, 3.4%-10.6%). No clinically or radiologically diagnosed pulmonary embolism occurred in patients with DVT. No independent risk factor associated with DVT was identified. Hospital mortality in those with and those without DVT was 42.9% and 32.3%, respectively. There was no significant difference in the length of ICU or hospital stay or inpatient mortality between those with and those without DVT. Conclusion: Without thromboprophylaxis, the incidence of DVT in the Thai population remains low. A strategy of screening ultrasound 5 to 7 days after admission to the ICU may be a suitable alternative to anticoagulant prophylaxis in critically ill Thai patients without symptoms of venous thromboembolism.

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BACKGROUND: Immune Checkpoint Inhibitors (ICIs) have revolutionized cancer therapy. This study examines the cardiovascular risks of ICIs compared to non-ICI therapies. METHODS: Utilizing the Chang Gung Research Database (CGRD) of Taiwan, this retrospective study analyzed 188,225 cancer patients, with 1,737 undergoing ICI treatment from January 1, 2008, to June 30, 2021. Through 1:1 propensity score matching (PSM), we compared specific outcomes between patients treated with ICIs and those who were not. The analysis also accounted for the competing risk of mortality in assessing the results after PSM. The observation period spanned from this index date to whichever came first: the date of the specific outcomes, the last follow-up recorded, or the end date of the study on June 30, 2022. RESULTS: The study found no significant increase in the risk of cardiac death, non-fatal myocardial infarction, heart failure hospitalization, deep vein thrombosis, or pulmonary embolism in patients treated with ICIs as compared to those receiving non-ICI therapy. Interestingly, ICI treatment was linked to a lower risk of non-fatal stroke (0.27% per year vs. 0.46% per year; subdistribution hazard ratio = 0.59; 95% confidence interval = 0.35-0.98; P = 0.0430). Furthermore, subgroup analysis revealed that the ICI group had a decreased risk of cardiac death in patients with cancers other than head and neck cancer, and a reduced risk of stroke among diabetic patients. CONCLUSIONS: ICIs do not significantly elevate the risk of cardiovascular events in cancer patients and may lower the stroke risk, underscoring the need for additional prospective studies to clarify these findings.

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Objective: The purpose of the research is to explore post-thrombotic syndrome (PTS) after catheter-directed thrombolysis (CDT) treatment for acute lower extremity deep vein thrombosis (DVT) risk factors. Methods: We retrospectively selected 171 patients with acute lower extremity DVT undergoing CDT treatment, collected clinical data of the patients, grouped them according to the follow-up results of 1 year after treatment, and included patients with PTS into the concurrent group and patients who did not develop PTS assigned to the unconcurrent group. Univariate analysis and Logistic regression were applied to analyze the risk factors of PTS after catheterization and thrombolytic therapy for acute lower extremity DVT. We applied R4.2.3 software to build three hybrid machine-learning models, including a nomogram, decision tree, and random forest with independent influencing factors as predictive variables. Results: The incidence of PTS after CDT in acute lower extremity DVT was 36.84 %. BMI >24.33 kg/m2, disease time >7 d, mixed DVT, varicose vein history, stress treatment time>6.5 months, and filter category were independent risk factors for PTS after CDT treatment for acute lower extremity DVT. The AUC value predicted by the random forest model was higher than that of the nomogram model (Z = -2.337, P = 0.019) and the decision tree model (Z = -2.995, P = 0.003). Conclusion: The occurrence of PTS after CDT treatment of acute lower extremity DVT is closely related to many factors, and the established random forest model had the best effect in predicting PTS complicated with PTS.

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BACKGROUND: Venous thromboembolism (VTE) causes morbidity and mortality in cancer patients. The association of VTE with known risk factors in chronic lymphocytic leukemia (CLL) is not known. OBJECTIVE: To examine risk factors and mortality associated with VTE in White, Black, and Asian CLL patients. METHODS: The United States SEER-Medicare database (2000-2015) was used for CLL patients ≥ 65 years. Logistic regression was used to examine VTE risk factors and Cox proportional regression was used to evaluate the effect of VTE on mortality in White, Black, and Asian CLL patients. RESULTS: Among 34,075 CLL patients, VTE was diagnosed in 11.6 % of 31,395 White, 14.6 % of 2062 Black and 6.3 % of 618 Asian patients. Risk of having VTE was, ORa = 1.2 (95 % CI, 1.0-1.4) for Black patients and ORa = 0.5 (95 % CI, 0.4-0.7) for Asian patients compared to White patients. Anemia and heart failure were associated with VTE in all three racial cohorts and were the only risk factors in Asian patients. Other risk factors in White patients were the same as in the overall population, including hypertension, obesity, COPD, kidney disease, diabetes, hyperlipidemia, myocardial infarction, and chemotherapy. In Black patients, other risk factors were hypertension, and chemotherapy. Mortality was slightly higher with VTE in the overall population and in White patients. CONCLUSION: There was difference in VTE risk factors in White, Black, and Asian patients. VTE was marginally associated with mortality in CLL patients. Our findings may help to identify patients at higher risk of VTE in racially diverse CLL populations.

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Deep vein thrombosis (DVT) is a serious condition with a high disease burden. Pulmonary embolism is one of the disastrous complications of DVT. The etiology of DVT includes factors responsible for hypercoagulation, venous injury, and factors causing stasis in the deep veins. May-Thurner syndrome (MTS) is one of the rarely thought of causes of DVT. MTS is an anatomical variant where the right common iliac artery compresses the left common iliac vein against the lumbar vertebrae. This leads to thrombus formation and stenosis in the left common iliac vein at the site of cross-over, resulting in an iliofemoral DVT. We present a case of a young female who presented with acute bilateral pulmonary embolism and subsequent cardiac arrest. She was treated with mechanical thrombectomy, angioplasty, and stent placement under the umbrella of anticoagulant agents. We aim to present this case to highlight that MTS should be considered a differential etiological condition in iliofemoral DVT. MTS is a rarely considered condition by clinicians while evaluating patients with lower limb DVT. When unaddressed, MTS can lead to recurrent DVT, post-thrombotic syndrome, and fatal complications like pulmonary embolism. Clinicians should investigate for possible MTS in patients with left lower extremity venous thrombotic events, irrespective of the presence of other risk factors.

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Background Assessing DVT prevention awareness in the Al Qunfudhah region involves measuring public knowledge about risk factors, prevention, and early treatment through surveys. DVT, characterized by blood clots in the deep veins, poses serious risks, including pulmonary embolism. Raising awareness is crucial for high-risk groups, such as those with prolonged immobility or certain medical conditions, underscoring the need for targeted education and prevention strategies. Objectives The objective of the study is to determine the level of awareness regarding deep vein thrombosis (DVT) prevention measures among the general population of Al Qunfudhah governorate. Methods This cross-sectional study was conducted in Al Qunfudhah, Saudi Arabia, from January 2024 to April 2024. Data were collected using an online questionnaire targeting individuals aged 18-65 in the region. Analysis was performed using RStudio software version 4.3.1. Results Most participants (69.0%) lacked familiarity with DVT. Their knowledge of risk factors, symptoms, prevention strategies, and complications was limited, with a median knowledge score of 8 out of 21 (IQR: 5-11). Familiarity with DVT was an independent predictor of higher knowledge (ß = 4.29, 95% CI 3.58-5.00, p < 0.001). Conclusions Awareness and knowledge regarding DVT prevention among residents of Al Qunfudhah were found to be inadequate. Targeted educational interventions are needed to improve understanding of DVT and its prevention, especially among those unfamiliar with the condition.

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Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease. While various inflammatory conditions have been linked to venous thromboembolism (VTE), the risk of VTE among patients with AD remains unclear. We sought to systematically review and meta-analyze population-based studies to determine the association between AD and incident VTE. A systematic review was performed of published studies in PubMed, Web of Science, Embase and Cochrane library from their inception to 27 May 2024. At least two reviewers conducted title/abstract, full-text review and data extraction. Cohort studies examining the association of AD with incident VTE were included. Quality of evidence was assessed using the Newcastle-Ottawa Scale. Six cohort studies, encompassing a total of 10,186,861 participants, were included. The meta-analysis revealed a significantly increased risk for incident VTE among AD patients (pooled hazard ratio (HR), 1.10; 95% CI, 1.00-1.21), with an incidence rate of VTE at 3.35 events per 1000 patient-years. Individual outcome analyses suggested that AD was associated with higher risks of deep vein thrombosis (pooled HR, 1.15; 95% CI, 1.04-1.27) but not pulmonary embolism (pooled HR, 0.99; 95% CI, 0.87-1.13). This systematic review and meta-analysis indicated an increased risk of incident VTE among patients with AD. Future studies are necessary to elucidate the underlying pathophysiology of the association between AD and VTE.

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Inpatient management of low-risk patients with venous thromboembolism (VTE) places a large resource burden on the healthcare system. Adult patients diagnosed with deep vein thrombosis (DVT) or pulmonary embolism (PE) in the emergency department (ED) have historically been hospitalized and treated with therapeutic anticoagulation. However, over the last two decades, outpatient treatment of patients with acute DVT and low risk PE has become increasingly accepted as an effective and safe option for patients given the low risk of short-term clinical deterioration. The purpose of this project was to establish a transition of care (TCM) program for patients with acute VTE presenting to the ED. The primary goals for the project included better quality patient follow-up in the Vascular Medicine Nurse Practitioner (NP) within one week and medication adherence. The second goal was increasing appropriate ED discharges for patients with low-risk VTE. Outcome metrics include the rate of early discharge of low-risk patients with VTE, follow-up in the Vascular Medicine NP clinic, and anticoagulant adherence.

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The need for safe and effective methods to manage deep vein thrombosis (DVT), given the risks associated with anticoagulants and thrombolytic agents, motivated research into innovative approaches to resolve blood clots. In response to this challenge, sonothrombolysis is being explored as a technique that combines microbubbles, ultrasound, and thrombolytic agents to facilitate the aggressive dissolution of thrombi. Prior studies have indicated that relatively large microbubbles accelerate the dissolution process, either in an in vitro or an arterial model. However, sonothrombolysis using large microbubbles must be evaluated in venous thromboembolism diseases, where blood flow velocity is not comparable. In this study, the efficacy of sonothrombolysis was validated in a murine model of pre-existing DVT. During therapy, microfluidically produced microbubbles of 18 µm diameter and recombinant tissue plasminogen activator (rt-PA) were administered through a tail vein catheter for 30 min, while ultrasound was applied to the abdominal region of the mice. Three-dimensional ultrasound scans were performed before and after therapy for quantification. The residual volume of the thrombi was 20% in animals post sonothrombolysis versus 52% without therapy ( p = 0.012 < 0.05 ), indicating a significant reduction in DVT volume. Histological analysis of tissue sections confirmed a reduction in DVT volume post-therapy. Therefore, large microbubbles generated from a microfluidic device show promise in ultrasound-assisted therapy to address concerns related to venous thromboembolism.

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Deep venous thrombosis is a common and potentially life-threatening condition that is often associated with various risk factors including underlying malignancy. In this case report, we present a male patient who presented with deep venous thrombosis as the earliest presenting feature of metastatic gallbladder carcinoma. This case report emphasizes the importance of thorough evaluation of patients presenting with unprovoked deep venous thrombosis to early detection of underlying malignancy.

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One of the main causes of unfavorable pregnancy outcomes in expectant mothers is pregnancy-associated venous thromboembolism. Although pregnancy-related venous thromboembolism does not always manifest obvious clinical symptoms and lacks a comprehensive standard risk assessment and prediction system as well as simple and effective laboratory testing techniques, timely and accurate diagnosis can still help reduce the probability of adverse pregnancy outcomes. To aid in the early detection, diagnosis, and treatment of pregnancy- associated venous thromboembolism, we attempt to provide an overview of the radiological diagnostic techniques for various forms of the condition.

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BACKGROUND: Venous thromboembolism (VTE) is a leading cause of death among cancer patients. Despite this, studies show that patients with cancer feel inadequately informed about the VTE risk and symptoms, which may impede their ability to recognise symptoms and react promptly. Patients with lung cancer are especially vulnerable due to a high relative risk of developing VTE combined with a high prevalence of low health literacy. This study aimed to explore the VTE information needs of lung cancer patients and how patients and healthcare professionals (HCPs) communicate about VTE. MATERIAL AND METHODS: Data was collected via semi-structured interviews with patients with lung cancer and HCPs. All participants (n = 20) were recruited from an oncological department. The analysis was performed in an inductive manner using a Ricoeur inspired strategy. FINDINGS: Patients had varying information needs regarding VTE, but HCPs did not routinely communicate about VTE, as the topic tended to be lowly prioritised. HCPs communicated about VTE when patients expressed a need or presented symptoms of VTE. HCPs expressed concerns about adding to patient's emotional burden by informing about VTE, while some patients emphasised the importance of being mentally prepared for potential complications. CONCLUSION: The study demonstrates the challenging balance HCPs must maintain between adequately communicating about VTE and not causing undue psychological distress. However, given patient's often limited awareness of VTE, the responsibility to initiate communication about VTE must fall on the HCPs.

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BACKGROUND: Deep vein thromboembolism (DVT) is a common postoperative complication with high morbidity and mortality rates. However, the safety and effectiveness of using prophylactic anticoagulants for preventing DVT after spinal surgery remain controversial. Hence, it is crucial to predict whether DVT occurs in advance following spinal surgery. The present study aimed to establish a machine learning (ML)-based prediction model of DVT formation following spinal surgery. METHODS: We reviewed the medical records of patients who underwent elective spinal surgery at the Third Affiliated Hospital of Zunyi Medical University (TAHZMU) from January 2020 to December 2022. We ultimately selected the clinical data of 500 patients who met the criteria for elective spinal surgery. The Boruta-SHAP algorithm was used for feature selection, and the SMOTE algorithm was used for data balance. The related risk factors for DVT after spinal surgery were screened and analyzed. Five ML algorithm models were established. The data of 150 patients treated at the Affiliated Hospital of Zunyi Medical University (AHZMU) from July 2023 to October 2023 were used for external verification of the model. The area under the curve (AUC), geometric mean (G-mean), sensitivity, accuracy, specificity, and F1 score were used to evaluate the performance of the models. RESULTS: The results revealed that activated partial thromboplastin time (APTT), age, body mass index (BMI), preoperative serum creatinine (Crea), anesthesia time, rocuronium dose, and propofol dose were the seven important characteristic variables for predicting DVT after spinal surgery. Among the five ML models established in this study, the random forest classifier (RF) showed superior performance to the other models in the internal validation set. CONCLUSION: Seven preoperative and intraoperative variables were included in our study to develop an ML-based predictive model for DVT formation following spinal surgery, and this model can be used to assist in clinical evaluation and decision-making.

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INTRODUCTION: Inferior vena cava agenesis (IVCA), a rare congenital anomaly, contributes to approximately 5 % of deep venous thrombosis (DVT) cases lacking other risk factors. It can lead to chronic venous insufficiency and DVT when collateral circulation is insufficient, presenting diagnostic challenges due to its rarity. CASE PRESENTATION: We present two cases of Absent IVC (AIVC) in young males. Case 1: a 22-year-old developed bilateral lower limb DVT post-appendectomy. Imaging revealed AIVC with azygos continuation. Treatment included Heparin and Rivaroxaban, achieving symptom resolution. Case 2: a 41-year-old with recurrent DVT and chronic venous insufficiency was diagnosed with AIVC via venography. Managed with warfarin and compression therapy, his symptoms stabilized. CLINICAL DISCUSSION: These cases underscore the importance of recognizing AIVC in young patients presenting with unexplained DVT. Diagnosis often requires advanced imaging techniques like CT venography. Management typically involves long-term anticoagulation and compression therapy to mitigate the risk of recurrence and chronic venous complications. CONCLUSION: Early identification of AIVC in young adults presenting with recurrent DVT is essential for appropriate management and prevention of long-term complications.

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Several aspects of the management of post-thrombotic syndrome (PTS) are still a matter of debate, or not yet addressed in international guidelines. The objective of this expert consensus from the French Society of Vascular Medicine (SFMV) and the French Society of Cardiovascular Imaging (SFICV) was to define the main elements of diagnosis and treatment of this syndrome, and to develop a proposal for its preoperative, procedural and follow-up management. In this consensus, the following issues were addressed: clinical and ultrasound diagnosis; pre-procedural workup; indications and contraindications to venous recanalisation; procedures; clinical and duplex ultrasound reports; follow-up; long-term treatment; management of great saphenous vein incompetency; anticoagulant and antiplatelet therapy after venous stenting.

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Background: Assessing the age of deep vein thrombosis (DVT) is crucial for guiding treatment approaches. Two-dimensional shear-wave elastography (2D-SWE) and super-microvascular imaging (SMI), as emerging techniques for tissue elasticity assessment and intrathrombus microvascular analysis, are pivotal for accurate thrombus age determination. This research endeavors to classify DVT into acute, subacute, and chronic ages utilizing these imaging methods. Methods: The study is a prospective, single-center, inpatient investigation that utilized convenience sampling for participant recruitment. Patients with a symptom duration of <6 months who were found to have lower-extremity DVT on ultrasound (US) between January 2021 and March 2022 after craniocerebral trauma (CT) or bone injury (BI) operations were included in this study. Participants were divided into three groups based on the duration of DVT, measured from the first diagnosis of thrombosis by US to the follow-up with 2D-SWE and SMI: acute (≤14 days), subacute (15-30 days), and chronic (31 days to 6 months) All patients underwent 2D-SWE and SMI using an Aplio i700 Ultrasound System equipped with a PLT-1005BT line array probe. Diagnostic performance was assessed using the area under the receiver operating characteristic (ROC) curve. Results: The maximum value of the elastic modulus for DVT (DVT_Emax), the mean value of the elastic modulus for DVT (DVT_Emean), and SMI's flow distribution scoring pattern for DVT (SMI_scoring) emerged as significant predictors for acute and chronic, with high area under the ROC curve (AUC) of acute [AUC (95% confidential interval): 0.95 (0.89-0.97), 0.96 (0.91-0.98), 0.93 (0.88-0.97) in 39 patients] and chronic [AUC (95% confidential interval): 0.88 (0.81-0.93), 0.94 (0.88-0.97), 0.91 (0.84-0.95) in 51 patients], respectively. However, these indices had lower efficacy for subacute prediction [AUC (95% confidential interval): 0.51 (0.42-0.60), 0.54 (0.46-0.63), 0.53 (0.44-0.62), in 47 patients]. Combining DVT_Emean with SMI_scoring improved performance in predicting subacute: 0.90 (0.83-0.94) than related features alone. Conclusions: Both 2D-SWE and SMI can be used to assess acute and chronic DVT in patients with CT and BI after surgeries. This combination is a promising adjunctive technique for identifying the subacute phase of DVT in these patients.

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Teaching point: Although deep vein thrombosis is a common concern after lumbar arthrodesis, rare complications such as an iatrogenic arteriovenous fistula can present similarly, highlighting the importance of a broad, differential diagnosis and appropriate imaging for timely management.