Vascular medicine
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Thromboprophylaxis remains often underused in hospitalized patients. In 2001, a cohort study done at our institution, a tertiary care center in Montreal, Canada, showed that 67.7% of VTE cases necessitating thromboprophylaxis were potentially preventable with adequate use of American College of Chest Physicians (ACCP) guidelines. Following implementation of an institution-wide policy in 2005, we assessed the changes in the rate of potentially preventable VTE. ⋯ The potentially preventable cases were mostly due to omission of thromboprophylaxis (50.9%), occurred during general medical admissions (74.5%), and the most common VTE risk factor was cancer (47.2%). In conclusion, we demonstrate a lower frequency of potentially preventable cases in 2010 compared to 2001 (39.3% vs 67.7%, respectively), partially due to physician education and adoption of an institution-wide policy. However, patients with medical indications for thromboprophylaxis, particularly those with cancer, are more prone to having preventable VTE, indicating an area for potential improvement.
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Randomized Controlled Trial
Efficacy of a short course of complex lymphedema therapy or graduated compression stocking therapy in the treatment of post-thrombotic syndrome.
Treatment options for established post-thrombotic syndrome (PTS) are limited. Complex lymphedema therapy (CLT), a non-invasive treatment that improves lymphatic flow, may have the potential to improve PTS. We conducted a single-center, investigator-blind, randomized controlled trial of 31 patients with a clinically established diagnosis of PTS and compared the efficacy of graduated compression stockings alone (30-40 mmHg) with CLT, a treatment that includes compression stockings, exercise, patient education, skin care and lymphatic drainage. ⋯ Patients with moderate to severe PTS derived the greatest benefit from either therapy and the two therapies differentially impacted PTS signs and symptoms. We found a short course of lymphedema therapy and compression stockings offer similar benefit in patients with PTS; however, larger studies are needed to further explore the potential use of CLT in PTS, particularly in patients with more severe disease. ClinicalTrials.gov Identifier: NCT00633971.
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Increased levels of plasma troponins and natriuretic peptides are markers of cardiac dysfunction associated with increased risk of cardiovascular disease. Little information exists on cardiac dysfunction and occurrence of venous thromboembolism (VTE). ⋯ In both ARIC and CHS, TnT was associated positively with incidence of total VTE and provoked VTE, but not with unprovoked VTE: age, race, and sex-adjusted hazard ratios for total VTE in the pooled analysis were 1.00, 0.85, 1.36, 1.51, and 1.98 (p-trend <0.0001) across five categories of TnT. In contrast, the association of NT-proBNP with VTE was positive in ARIC (hazard ratios approximately 2.5-fold for the highest versus lowest NT-proBNP quintiles), but non-existent in CHS.