Title: Clinicoetiological Profile and Management of Deep Vein Thrombosis (DVT) of Lower Limb
Authors: Rajiv Ranjan, Kishore K. Sinha, Mahesh Chaudhary
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.17
Abstract
Background: Venous thrombosis of deep vein is a serious life threatening condition that may lead to sudden death in short term or to long term morbidity due to development of a post thrombotic limb and venous ulceration. The most frequent location of deep vein thrombosis is in the lower limb. In 10% of patients who die in hospital, the cause of death is pulmonary embolism following a lower limb deep vein thrombosis. In India, the incidence of deep vein thrombosis (DVT) is not well highlighted and literature survey shows little works in this field.
Objectives: To study patterns of clinical presentation, etiology and management of deep vein thrombosi of lower limb..
Material & Methods: A 2 year study of DVT in lower limb conducted at Anugrah Narayan Magadh Medical College Hospital, Gaya, Bihar, India. Patients were admitted from both surgery OPD as well as from Central Casualty. The risk factors, response to treatment, clinical course were documented using physical examination and relevant laboratory tests at regular intervals. The data was prospectively analyzed.
Conclusion: Most of the DVTs are idiopathic or primary and occur in less than 45 years age group. Irrespective of the etiology, LMWH and Warfarins are efficient, safety is well recognised, and home based treatment is advisable with follow up. Idiopathic DVTs require long term follow up to watch for recurrent thrombosis. Further studies are necessary to stratify risks, and incidence in Indian population.
Keywords: Deep Vein Thrombosis, India, Low molecular weight heparins, Warfarin, VTE, DVT.
References
- Felipe N, John RB. Deep Vein Thrombosis. In: Young JR, Olin JW, Bartholomew JR, editors. Peripheral Vascular Disease. 2nd ed. New York: Mosby; 1996. p. 451-65.
- Hansson PO, Welin L, Tibblin G, Eriksson H. Deep vein thrombosis and pulmonary embolism in the general population. Arch Intern Med 1997;157:1665-70.
- Agarwala S, Bhagwat AS, Modhe J. Deep vein thrombosis in Indian patients undergoing major lower limb surgery. Ind J Surg 2003;65:159-62.
- Agarwala S, Bhagwat AS, Wadhwani R. Pre and post operative DVT in Indian patients – Efficacy of LMWH as a prophylaxis agent. Ind J Orth 2005;39:558.
- Sharma SK, Gupta V, Kadhiravan T, Banga A, Seith A, Kumar AA, et al. Prospective study of risk factor profile and incidence of deep venous thrombosis among medicallyill‑ hospitalized patients at a tertiary care hospital in northern India. Indian J Med Res 2009;130:726-30.
- Schaub RG, Simmons CA, Koers MH. Early events in the formation of a venous thrombus following local trauma and stasis. Lab Invest 1984;51:218-24.
- Scurr JH. Venous disorders. In: Russell RCG, Williams NW, Christopher BJK, eds. In: Bailey and Love's Short Practice of Surgery. 24th ed. London: Hodder Arnold 2004.p.954-73.
- Lam EY, Giswold ME, Moneta GL. Venous and lymphatic disease. In: Brunicardi FC, Andersen DK, Billar TR, Dunn DL, Hunter JG, Pollock RE, eds. Schwartz's Principles of Surgery. 8thed. New York: McGraw Hill 2005.p.809-34.
- Piovella F, Wang CJ, Lu H, Lee K, Lee LH, Lee WC, et al.; AIDA investigators. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemi-ological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost 2005;3:2664–70.
- Kakkar N, Vasishta RK. Pulmonary embolism in medical patients: An autopsy-based study. Clin Appl Thromb Hemost 2008;14:159–67.
- Sharma SK, Gupta V, Kadhiravan T, Banga A, Seith A, Kumar AA, et al. Prospective study of risk factor profile and incidence of deep venous thrombosis among medically‑ill hospitalized patients at a tertiary care hospital in northern India. Indian J Med Res 2009;130:726‑30.
- Emeka Kesieme, Chinenye Kesieme, Nze Jebbin, Eshiobo Irekpita, Andrew Dongo J Blood Med. 2011; 2: 59–69. Published online 2011 Apr 29. doi: 10.2147/JBM.S19009 PMCID: PMC3262341.
- Kasabe PS, Jaykar RD, Lakhpatre SB.Astudy of clinical profile of 50 patients with deep venous thrombosis at general hospital. Med Pulse – International Medical Journal 2014;1(10):676-80.
- Caprini JA, Arcelus JI, Hoffman KN et al. Venous duplex imaging follow-up of acute symptomatic deep vein thrombosis of the leg. J Vasc Surg 1995;21:472-6.
- Killewich LA, Bedford GR, Beach KW et al. Spontaneous lysis of deep venousthrombi: rate and outcome. J Vasc Surg 1989;9:89–97.
- Oger E. Incidence of venous thromboembolism: a community-based study in western France. EPI-GETBP Study Group. Groupe d’Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 2000; 83: 657-660.
- Saarinen J. Incidence, risk associations and outcome of Deep Venous Thrombosis in the lower limb [dissertation. Tempere: University of Tempere; 2000. p. 1‑50.
- Agarwala S, Bhagwat AS, Modhe J. Deep vein thrombosis in Indian patients undergoing major lower limb surgery. Ind J Surg 2003;65:159‑62.;8= Shukla PJ, Siddachari R, Ahire S, Arya S, Ramani S, Barreto SG, et al. Postoperative deep vein thrombosis in patients with colorectal cancer. Indian J Gastroenterol 2008;27:71‑3.
- Pannucci CJ, Diaz JA, Wahl WL. Temporal changes in DVT risk after electrical injury. J Burn Care Res 2011;32:442‑6.
- Pilger E, Obernosterer A, Stark G, Decrinis M. Etiology of deep venous thrombosis of the leg. Acta Med Austriaca 1991;18:68‑72.
- Monreal M, Trujillo‑Santos. Screening for occult cancer in patients with acute venous thromboembolism. Curr Opin Pulm Med 2007;13:368‑71.
- Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al.; American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008;133 (6 Suppl):381S–453S.