Comparative Study of Deep Vein Thrombosis Recanalization Using Doppler Ultrasound in Different Post-Treatment Intervals in Traumatic Patients
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Abstract
Deep vein thrombosis (DVT) is a prevalent vascular disease characterized by pelvic and limb deep vein thrombophlebitis, and it has a high incidence in traumatic patients. Contrary to older studies, recent research has reported that recanalization in DVT is not a slow process. The present study aimed at the comparative examination of DVT recanalization with Doppler ultrasound in different intervals following treatment with heparin or enoxaparin. This prospective study was conducted on all traumatic patients hospitalized in Imam Reza Hospital of Kermanshah, Iran, with the clinical and sonographic diagnosis of DVT in limb veins. Doppler ultrasound was performed two weeks, one month, and three months following treatment in order to examine recanalization. Data were analyzed using statistical tests in SPSS16 at the significance level of <0.05. Based on Doppler ultrasound, a significant difference was found between the degree of recanalization in patients aged <45 years and those aged >45 years, between male and female patients, and between different DVT locations (P<0.05). After three months of treatment with heparin and enoxaparin, the degree of recanalization was increased in DVT. Moreover, it was found that Doppler ultrasound is a useful tool for the diagnosis of recanalization in patients with DVT.
1. Geerts WH, Code KJ, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med 1994;331:1601-6.
2. Sevitt S, Gallagher N. Venous thrombosis and pulmonary embolism. A clinico-pathological study in injured and burned patients. Br J Surg 1961;48:475-89.
3. Godat LN, Kobayashi L, Chang DC, Coimbra R. Can we ever stop worrying about venous thromboembolism after trauma? J Trauma Acute Care Surg 2015;78:475-80.
4. Differding JA, Underwood SJ, Van PY, Khaki RA, Spoerke NJ, Schreiber MA. Trauma induces a hypercoagulable state that is resistant to hypothermia as measured by thromboelastogram. Am J Surg 2011;201:587-91.
5. Gearhart MM, Luchette FA, Proctor MC, Lutomski DM, Witsken C, James L, et al. The risk assessment profile score identifies trauma patients at risk for deep venous thrombosis. Surgery 2000;128:631-7.
6. Spinella PC, Carroll CL, Staff I, Gross R, Mc Quay J, Keibel L, et al. Duration of red blood cell storage is associated increased incidence of deep venous thrombosis and in hospital mortality in patients with traumatic injuries. Crit Care 2009;13:R151.
7. Hutchinson TN, Krueger CA, Berry JS, Aden JK, Cohn SM, White CE, et al. Venous thromboembolism during combat operations: a 10-y review. J Surg Res 2014;187:625-30.
8. Knudson MM. Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank. Ann Surg 2004;240:490-6.
9. Smith SF, Biggs MT, Sekhon LH. Risk factors and prophylaxis for deep venous thrombosis in neurosurgery. Surg Technol Int 2005;14:69-76.
10. Braunwald E, Fauci AS, Kasper D, Hauser SL, Longo DL, Jameson JL. Harrison’s principles of internal medicine. 16th ed. New York: McGraw Hill. 2005.
11. Cushman M. Epidemiology and Risk Factors for Venous Thrombosis. Semin Hematol. 2007;44:62-9.
12. Samam MM. An Epidemiologic Study of Risk Factors for Deep Vein Thrombosis in Medical Outpatients. Arch Intern Med 2000;160:3415-20.
13. Hirsh J, Hoak J. Management of Deep Vein Thrombosis and Pulmonary Embolism. A Statement for Healthcare Professionals From the Council on Thrombosis (in Consultation With the Council on Cardiovascular Radiology), American Heart Association. Circulation 1996;93:2212-45.
14. Lee S, Gibson CM. Enoxaparin in acute coronary syndromes. Expert Rev Cardiovasc Ther 2007;5:387-99.
15. Paul G, Charles S. Acute pulmonary embolism: Imaging in the emergency department. Radiol Clin North Am 2000;44:259-71.
16. Bergvall U, Hjelmstedt A. Recanalisation of deep venous thrombosis of the lower leg and thigh. A phlebographic study of fracture cases. Acta Chir Scand 1968;134:219-28.
17. Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolysis 2009;28:465-76.
18. Killewich LA, Macko RF, Cox K, Franklin DR, Benjamin ME, Lilly MP, Flinn WR, et al. Regression of proximal deep venous thrombosis is associated with fibrinolytic enhancement. J Vasc Surg 1997;26:861-8.
19. Brandão GM, Sobreira ML, Malgor RD, Rollo HA. Recanalization rates after acute deep vein thrombosis: a single-center experience using a newly proposed vein diameter variation index. Ann Vasc Surg 2014;28:1751-60.
20. Meissner MH, Zierler BK, Bergelin RO, Chandler WL, Strandness DE Jr. Coagulation, fibrinolysis, and recanalization after acute deep venous thrombosis. J Vasc Surg 2002;35:278-85.
21. Puskás A, Balogh Z, Hadadi L, Imre M, Orbán E, Kósa K, Brassai Z, Mousa SA.Spontaneous recanalization in deep venous thrombosis: a prospective duplex ultrasound study. Int Angiol. 2007;26:53-63.
22. Yang YH, Zhai ZG, Wang F, Xie WM, Wang C. [Changes in deep venous thrombosis after thrombolytic anticoagulant therapies in acute pulmonary thromboembolism. Zhonghua Nei Ke Za Zhi. 2009;48:371-4.
23. Lee CY, Lai ST, Shih CC, Wu TC. Short-term results of catheter-directed intrathrombus thrombolysis versus anticoagulation in acuteproximal deep vein thrombosis. J Chin Med Assoc 2013;76:265-70.
24. Strijkers RH, de Wolf MA, Arnoldussen CW, Timbergen MJ, de Graaf R, ten Cate-Hoek AJ, et al. Venous in-stent thrombosis treated by ultrasound accelerated catheter directed thrombolysis. Eur J Vasc Endovasc Surg 2015;49:440-7.
25. Ezelsoy M, Turunc G, Bayram M. Early Outcomes of Pharmacomechanical Thrombectomy in Acute Deep Vein Thrombosis Patients. Heart Surg Forum 2015;18:E222-5.
26. Sultanov DD, Gaibov AD, Toirov MG. [Anticoagulant therapy in comprehensive treatment of acute thrombosis of lower-limb deep veins]. Angiol Sosud Khir 2012;19:11-6.
27. Vorob'eva NM, Panchenko EP, Ermolina OV, Balakhonova TV, Dobrovol'skiĭ AB, Titaeva EV, et al. [Prolongation of enoxaparin therapy to one month promotes recanalization of the occlusively thrombosed deep veins]. Ter Arkh 2011;83:33-7.
28. Jia Z, Tu J, Zhao J, Ren B, Tian F, Wang K, et al. Aspiration thrombectomy using a large-size catheter for acute lower extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2016;4:167-71.
29. Guarnera G, Abeni D, Antignani PL, Apollonio A, Conti F, Mollo PL, et al. Update on distal deep venous thrombosis. Reports of a multicenter study. Int Angiol 2014;33:560-4.
30. Majdi-Nasab N, Shamsaei G, Faraji A, Haj-Manoochehri R, Abbasi V. Comparison of efficacy compressive stockings with heparin in prevention of deep vein thrombosis in stroke patients. Z J Res Med Sci 2013;15:73-5.
2. Sevitt S, Gallagher N. Venous thrombosis and pulmonary embolism. A clinico-pathological study in injured and burned patients. Br J Surg 1961;48:475-89.
3. Godat LN, Kobayashi L, Chang DC, Coimbra R. Can we ever stop worrying about venous thromboembolism after trauma? J Trauma Acute Care Surg 2015;78:475-80.
4. Differding JA, Underwood SJ, Van PY, Khaki RA, Spoerke NJ, Schreiber MA. Trauma induces a hypercoagulable state that is resistant to hypothermia as measured by thromboelastogram. Am J Surg 2011;201:587-91.
5. Gearhart MM, Luchette FA, Proctor MC, Lutomski DM, Witsken C, James L, et al. The risk assessment profile score identifies trauma patients at risk for deep venous thrombosis. Surgery 2000;128:631-7.
6. Spinella PC, Carroll CL, Staff I, Gross R, Mc Quay J, Keibel L, et al. Duration of red blood cell storage is associated increased incidence of deep venous thrombosis and in hospital mortality in patients with traumatic injuries. Crit Care 2009;13:R151.
7. Hutchinson TN, Krueger CA, Berry JS, Aden JK, Cohn SM, White CE, et al. Venous thromboembolism during combat operations: a 10-y review. J Surg Res 2014;187:625-30.
8. Knudson MM. Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank. Ann Surg 2004;240:490-6.
9. Smith SF, Biggs MT, Sekhon LH. Risk factors and prophylaxis for deep venous thrombosis in neurosurgery. Surg Technol Int 2005;14:69-76.
10. Braunwald E, Fauci AS, Kasper D, Hauser SL, Longo DL, Jameson JL. Harrison’s principles of internal medicine. 16th ed. New York: McGraw Hill. 2005.
11. Cushman M. Epidemiology and Risk Factors for Venous Thrombosis. Semin Hematol. 2007;44:62-9.
12. Samam MM. An Epidemiologic Study of Risk Factors for Deep Vein Thrombosis in Medical Outpatients. Arch Intern Med 2000;160:3415-20.
13. Hirsh J, Hoak J. Management of Deep Vein Thrombosis and Pulmonary Embolism. A Statement for Healthcare Professionals From the Council on Thrombosis (in Consultation With the Council on Cardiovascular Radiology), American Heart Association. Circulation 1996;93:2212-45.
14. Lee S, Gibson CM. Enoxaparin in acute coronary syndromes. Expert Rev Cardiovasc Ther 2007;5:387-99.
15. Paul G, Charles S. Acute pulmonary embolism: Imaging in the emergency department. Radiol Clin North Am 2000;44:259-71.
16. Bergvall U, Hjelmstedt A. Recanalisation of deep venous thrombosis of the lower leg and thigh. A phlebographic study of fracture cases. Acta Chir Scand 1968;134:219-28.
17. Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolysis 2009;28:465-76.
18. Killewich LA, Macko RF, Cox K, Franklin DR, Benjamin ME, Lilly MP, Flinn WR, et al. Regression of proximal deep venous thrombosis is associated with fibrinolytic enhancement. J Vasc Surg 1997;26:861-8.
19. Brandão GM, Sobreira ML, Malgor RD, Rollo HA. Recanalization rates after acute deep vein thrombosis: a single-center experience using a newly proposed vein diameter variation index. Ann Vasc Surg 2014;28:1751-60.
20. Meissner MH, Zierler BK, Bergelin RO, Chandler WL, Strandness DE Jr. Coagulation, fibrinolysis, and recanalization after acute deep venous thrombosis. J Vasc Surg 2002;35:278-85.
21. Puskás A, Balogh Z, Hadadi L, Imre M, Orbán E, Kósa K, Brassai Z, Mousa SA.Spontaneous recanalization in deep venous thrombosis: a prospective duplex ultrasound study. Int Angiol. 2007;26:53-63.
22. Yang YH, Zhai ZG, Wang F, Xie WM, Wang C. [Changes in deep venous thrombosis after thrombolytic anticoagulant therapies in acute pulmonary thromboembolism. Zhonghua Nei Ke Za Zhi. 2009;48:371-4.
23. Lee CY, Lai ST, Shih CC, Wu TC. Short-term results of catheter-directed intrathrombus thrombolysis versus anticoagulation in acuteproximal deep vein thrombosis. J Chin Med Assoc 2013;76:265-70.
24. Strijkers RH, de Wolf MA, Arnoldussen CW, Timbergen MJ, de Graaf R, ten Cate-Hoek AJ, et al. Venous in-stent thrombosis treated by ultrasound accelerated catheter directed thrombolysis. Eur J Vasc Endovasc Surg 2015;49:440-7.
25. Ezelsoy M, Turunc G, Bayram M. Early Outcomes of Pharmacomechanical Thrombectomy in Acute Deep Vein Thrombosis Patients. Heart Surg Forum 2015;18:E222-5.
26. Sultanov DD, Gaibov AD, Toirov MG. [Anticoagulant therapy in comprehensive treatment of acute thrombosis of lower-limb deep veins]. Angiol Sosud Khir 2012;19:11-6.
27. Vorob'eva NM, Panchenko EP, Ermolina OV, Balakhonova TV, Dobrovol'skiĭ AB, Titaeva EV, et al. [Prolongation of enoxaparin therapy to one month promotes recanalization of the occlusively thrombosed deep veins]. Ter Arkh 2011;83:33-7.
28. Jia Z, Tu J, Zhao J, Ren B, Tian F, Wang K, et al. Aspiration thrombectomy using a large-size catheter for acute lower extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2016;4:167-71.
29. Guarnera G, Abeni D, Antignani PL, Apollonio A, Conti F, Mollo PL, et al. Update on distal deep venous thrombosis. Reports of a multicenter study. Int Angiol 2014;33:560-4.
30. Majdi-Nasab N, Shamsaei G, Faraji A, Haj-Manoochehri R, Abbasi V. Comparison of efficacy compressive stockings with heparin in prevention of deep vein thrombosis in stroke patients. Z J Res Med Sci 2013;15:73-5.
| Files | ||
| Issue | Vol 60, No 1 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v60i1.8324 | |
| Keywords | ||
| Deep vein thrombosis recanalization Doppler ultrasound Trauma | ||
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How to Cite
1.
Farshchian N, Farshchian N, Bahrami Kamangar P. Comparative Study of Deep Vein Thrombosis Recanalization Using Doppler Ultrasound in Different Post-Treatment Intervals in Traumatic Patients. Acta Med Iran. 2022;60(1):25-31.
