Clinical and Diagnostic Overview of Deep Vein Thrombosis
Özet
Deep vein thrombosis (DVT), which typically occurs in the deep veins of the lower extremities and can lead to fatal consequences such as pulmonary embolism, is a major cause of cardiovascular mortality. Along with acquired factors such as advanced age, immobilization, obesity, surgical interventions, major trauma, oral contraceptive use, and malignancy, inherited thrombophilia disorders like the Factor V Leiden mutation cumulatively increase the risk of DVT. The pathophysiology of the disease is based on the classic Virchow triad, consisting of endothelial damage, venous stasis, and hypercoagulability. Although more than half of DVT cases are asymptomatic, pain, swelling, tenderness, and increased temperature in the extremity are common in symptomatic patients. Since clinical signs are insufficient for a definitive diagnosis, the Wells scoring system, the highly sensitive D-Dimer laboratory test, and compression ultrasonography—which is non-invasive, inexpensive, and reproducible—are preferred primarily. Computed tomography and magnetic resonance venography play critical roles, especially in the diagnosis of proximal and iliac vein obstructions.
Referanslar
Di Nisio M, van Es N, Buller HR. Deep vein thrombosis and pulmonary embolism. Lancet. 2016 Dec 17;388(10063):3060-3073.
Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e278S–325S.
Fowkes FJ, Price JF, Fowkes FG. Incidence of diagnosed deep vein thrombosis in the general population. Eur J Vasc Endovasc Surg 2003;25:1-5.
T.C. Sağlık Bakanlığı ve Türk Nefroloji Derneği Ortak Raporu 2019. Erişim adresi: http://www.nefroloji. org.tr/folders/file/registry_2019.pdf
Murad MH, Elamin MB, Sidawy AN, Malaga G, Rizvi AZ, Flynn DN, et al. Autogenous versus prosthetic vascular access for hemodialysis: A systematic review and meta-analysis. J Vasc Surg 2008;48(5 Suppl):34S-47S.
Almasri J, Alsawas M, Mainou M, Mustafa RA, Wang Z, Woo K, et al. Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis. J Vasc Surg 2016;64:236-
Kniffin WD Jr, Baron JA, Barrett J, Birkmeyer JD, Anderson FA Jr. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med. 1994 25;154:861‐6.
National Institute of Clinical Excellence (NICE). Venous thromboembolism in the over 16’s: reducing the risk of hospital-acquired deep vein thrombosis and pulmonary embolism. NICE Guideline NG89. 2018. London: NICE.
Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med. 1989 Apr;82(4):203-5.
Cogo A, Lensing AW, Prandoni P, Hirsh J. Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound. Arch Intern Med 1993;153:2777-80.
Robert-Ebadi H, Righini M. Management of distal deep vein thrombosis. Thromb Res. 2017 Jan;149:48-55.
Bozkurt AK. Periferik arter ve ven hastalıkları ulusal tedavi kılavuzu 2016. İstanbul: Baycınar Tıbbi Yayıncılık; 2016.
Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Seminars in thrombosis and hemostasis. 2014;40(7):724‐735.
White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost. 2003 Sep;90(3):446-55.
Cook TM, Baylis RJ, Marjot R. Prophylaxis of venous thromboembolism. Regional anaesthesia reduces thromboembolic morbidity. BMJ. 1997 Apr 26;314(7089):1282.
Yentis SM. Anaesthetic technique and deep vein thrombosis. Br J Hosp Med. 1990 Jan;43(1):83.
Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994 Dec 15;331(24):1601-6.
van Stralen KJ, Rosendaal FR, Doggen CJ. Minor injuries as a risk factor for venous thrombosis. Archives of Internal Medicine. 2008;168(1):21-26.
Samama MM. Epidemiology of risk factors of deep venous thrombosis (DVT) of the lower limbs in community practice: the SIRIUS study. Thromb Haemost 1993;69:763.
Prandoni P, Lensing AW, Cogo A, Cuppini S, Villalta S, Carta M, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996 Jul 1;125(1):1-7. Venöz ve Lenfatik Sistem Hastalıkları
World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception: Venous thromboembolism disease. Lancet 1995;346(8990):1575–82.
Rocha AT, Paiva EF, Lichtenstein A, Milani R Jr, Cavalheiro CF, Maffei FH. Risk assessment algorithm and recommendations for venous thromboembolism prophylaxis in medical patients. Vasc Health Risk Manag. 2007;3(4):533-53.
Connors JM. Thrombophilia Testing and Venous Thrombosis. N Engl J Med. 2017;377(12):1177‐1187.
Yang X, Chang Y, Wei W. Endothelial Dysfunction and Inflammation: Immunity in Rheumatoid Arthritis. Mediators Inflamm. 2016;2016:6813016.
Stone J, Hangge P, Albadawi H, Wallace A, Shamoun F, Knuttien MG, et al. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther. 2017 Dec;7(Suppl 3):S276-S284.
Sun ML, Wang XH, Huang J, Wang J, Wang Y. [Comparative study on deep venous thrombosis onset in hospitalized patients with different underlying diseases]. Zhonghua Nei Ke Za Zhi. 2018 Jun 01;57(6):429-434.
Carroll BJ, Piazza G. Hypercoagulable states in arterial and venous thrombosis: When, how, and who to test? Vasc Med. 2018 Aug;23(4):388-399.
Kearon C. Natural history of venous thromboembolism. Circulation. 2003 Jun 17;107(23 Suppl 1):I22-30.
Demir M, Erdemli B, Kurtoğlu M, Ongen G. Ulusal Venoz Tromboembolizm Profilaksi ve Tedavi Kılavuzu. İstanbul: Cortex; 2010.
Shafer N, Duboff S. Physical signs in the early diagnosis of thrombophlebitis. Angiology. 1971 Jan;22(1):18-30.
Wells PS, Owen C, Doucette S, Fergusson D, Tran H. Does this patient have deep vein thrombosis? JAMA 2006;295:199-207.
Kruger PC, Eikelboom JW, Douketis JD, Hankey GJ. Deep vein thrombosis: update on diagnosis and management. Med J Aust. 2019 Jun;210(11):516-524.
Wells P, Anderson D. The diagnosis and treatment of venous thromboembolism. Hematology Am Soc Hematol Educ Program. 2013;2013:457-63.
Di Nisio M, Squizzato A, Rutjes AW, Buller HR, Zwinderman AH, Bossuyt PM. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review. J Thromb Haemost. 2007 Feb;5(2):296-304.
Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3):338S–400S.
Pomero F, Dentali F, Borretta V, Bonzini M, Melchio R, Douketis JD, et al. Accuracy of emergency physician-performed ultrasonography in the diagnosis of deep-vein thrombosis: a systematic review and meta-analysis. Thromb Haemost 2013;109:137–145.
Goodacre S, Sampson F, Thomas S, van Beek E, Sutton A. Systematic review and meta- analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging. 2005 Oct 3;5:6.
Watanabe H, Sekiya H, Kariya Y, Hoshino Y, Sugimoto H, Hayasaka S. The incidence of venous thromboembolism before and after total knee arthroplasty using 16-row multidetector computed tomography. J Arthroplasty 2011;26(8):1488–93.
Fraser DG, Moody AR, Morgan PS, Martel AL, Davidson I. Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med 2002;136(2):89–98.
