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DEEP VEIN THROMBOSIS (DVT) MAJ S B PANDEY

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DEEP VEIN THROMBOSIS (DVT)

MAJ S B PANDEY

What is Venous Thromboembolism?When a blood clot (thrombus) forms in a deep vein, this is called deep vein thrombosis (DVT)If it happens it happens most frequently in the leg

Thromboembolism occurs when part of a clot breaks away and enters the bloodstreamWhen this happens the blood clot is called an embolus

Embolus

A thrombus is a blood clot that consists of platelets, blood cells, coagulation factors and fibrin, and forms within blood vessels. Blood clots can adhere to the vessel wall, potentially causing an obstruction to blood flow.Venous thrombosis is the process whereby a clot (thrombus) forms within a vein. Deep vein thrombosis (DVT) is the most common type, usually occurring in the deep veins of the leg.Thromboembolism occurs when part or all of a thrombus breaks away from a blood vessel wall and this clot (now called an embolus) enters the bloodstream. Emboli are dangerous as they can cause blood vessel occlusion or obstruction. Patients with DVT are at high risk of pulmonary embolism (PE), which occurs when an embolus travels via the heart to lodge in an artery in the lungs.DVT and PE are collectively referred to as venous thromboembolism (VTE).

Immediate and long term effects of deep-vein thrombosisSymptoms and risk factorsPreventability of the condition

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VTE: deep vein thrombosis(DVT)andpulmonaryembolism(PE)MigrationPEEmbolusThrombusDVT

What is Pulmonary Embolism?Such an embolus can travel via the heart and lodge in an artery in the lungs, blocking blood flow to critical tissues - this is known as pulmonary embolism (PE)

Venous thromboembolism (VTE) includes DVT and PE

Embolus

A thrombus is a blood clot that consists of platelets, blood cells, coagulation factors and fibrin, and forms within blood vessels Blood clots can adhere to the vessel wall, potentially causing an obstruction to blood flow.Venous thrombosis is the process whereby a clot (thrombus) forms within a vein. Deep vein thrombosis (DVT) is the most common type, usually occurring in the deep veins of the leg.Thromboembolism occurs when part or all of a thrombus breaks away from a blood vessel wall and this clot (now called an embolus) enters the bloodstream. Emboli are dangerous as they can cause blood vessel occlusion or obstruction. Patients with DVT are at high risk of pulmonary embolism (PE), which occurs when an embolus travels via the heart to lodge in an artery in the lungs.DVT and PE are collectively referred to as venous thromboembolism (VTE).

Andrew Flintoff, cricketRebecca Bane, FilmsHilary Clinton, politicsSerena Williams, TennisDVTspares NOBODY

VTE: Often undetecteduntiltoolateOver 70% of fatal PE aredetected post-mortem1,3Approximately80% ofDVTs are clinically silent2,31. Stein PD, et al. Chest 19952. Lethen H, et al. Am J Cardiol 19973. Sandler DA, et al. J R Soc Med 1989

VTE is a serious disease that killshundredsofthousandspeople each year3rd most common cardiovasculardisease world-wide after ischaemicheart disease and stroke1Causes ~300,000 deaths in the United States and over 500,000 deaths in Europe per year2,3In the EU, more than twice as many people die from VTE than from AIDS, breast cancer, prostate cancer and transportation accidents combined33.1 billion Euros per year total estimated costs for VTE-associated care41.Goldhaber SZ at al; 1992.2.Heit JA,et al; 2005.3.Cohen AT, et al; 2007.4.Cohen AT; 2005

VTE is estimated to cause at least 3 million deaths a year worldwide; DVT & PE are common cause of CV mortality & morbidity3rd most common cardiovascular disease worldwide after IHD and strokeVTE is implicated in every 1 out 10 hospital deaths in the worldGlobal incidence of VTE : 1 in 1000 people all over the world are affected by VTE

1. Spyropoulos AC. Investigational treatments of venous thromboembolism. Expert Opin Investig Drugs. 2007;16:431-440. 2. Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboembolism (VTE) in Europe. Thromb Haemost. 2007;98:756-764. 3. Parakh R et al., JAPI. 55, Jan 2007; 4. Sharma S et al., IJS.63(2).2001 5. Geerts WH, et al. Chest. 2004;126(3 suppl):338S-400S.

Complications:

Post-thrombotic syndrome - occurs in 10% of patients with DVT Pulmonary hypertension occurs in 5% of patients with PEBurden of VTE

VTE is estimated to cause at least 3 million deaths a year worldwide; DVT & PE are common cause of CV mortality & morbidity3rd most common cardiovascular disease worldwide after ischemic heart disease and strokeVTE is implicated in one in ten hospital deaths in the world.Post-thrombotic syndrome and pulmonary hypertension occur in 10% of patients with DVT and 5% of patients with PE, respectively.VTE may occur in > 50% of patients undergoing hip & knee surgeriesPatients undergoing MOS i.e., hip & knee replacement, are at high risk for VTEGlobal incidence of VTE : 1 in 1000 people all over the world are affected by VTEIncidence of DVT in India - 1.79 per thousand - general population

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VirchowsTriadofThrombogenesisAlterations of vessel wall

VirchowsTriadofThrombogenesisEndothelial damageAlterations of vessel wall

First manifestationmay be fatal PEofdisease PE contributes to 1 in 10hospital deaths1 PE complications2:Permanent damage to the lungs and other organs Pulmonary hypertensionSudden death or cardiac arrest1. House of Commons Health Committee. Second report of session 200405. London: The StationaryOffice; March 2005.2. Goldhaber SZ. N Engl J Med 1998;339:93104.7

Post Thrombotic Syndrome (PTS) a severelong term complication of DVT PTS occurs in nearly one-third of patients within 5 years of initial DVT1 DVT-induced valvular incompetence PTS is characterised by3: Oedema Pain Induration Impaired viability of subcutaneous tissues Ulcerationleadstolowerlimbhypertension Severe PTS can lead to intractable, painfulvenous leg ulcers requiringand medical care4ongoingnursing Diepgen TL, et al. DermatologyOnline Atlas (Reprinted with permission).1. Prandoni P et al. 1996.2. Kahn SR et al. 2004.3. Anderson FA et al. 1998.4. Kahn SR et al. 200010

Radiology

Color Doppler ultrasound in Deep Venous Thrombosis

ENDORSE-multinationalcrosssectionalstudy1Cohen AT et al. Lancet 2008;371:38794

68 183 patients in 358 hospitals across 32 countries were enrolled:30 827 (45%) categorized as surgical37 356 (55%) categorized as medical

Objective The prevalence of VTE risk in the acute hospital care setting The proportion of at-risk patients who receive effective thromboprophylaxis

Mean = 52%

Patients at risk for VTE in 32countriesN= 68,1831009080706050403020100Cohen AT, et al. Lancet 2008;371: 387-394%

VTE in AsiaMultinational epidemiologic studies AIDA1 : Assessment of the Incidence of Deep-vein thrombosis in AsiaLocal epidemiologic studies China Hong Kong Singapore Thailand Indonesia Japan South Korea1 Piovella et al. J Thromb Haemost 2005Recent evidence from the last two decades suggest the incidence ofVTE in Asians is higher than previously believed

PE Indian Scenario : PGIMER, ChandigarhstudyAn autopsy study on 1000 medical patients at thePostgraduate Institute of Medical Education and Research(PGIMER), Chandigarh revealed-PE was present in 159 (16%) of 1000 patients who diedhospital in the1.2. InIt was a fatal embolus in 36A major contributor to death in 90 patients.30 patients, the embolus was an incidental finding atautopsy as death occurred due to some other cause.A clinical (pre-mortem) suspicion of PE was recorded inpatients and a diagnosis of PE could be made in