Deep venous thrombosis (DVT)
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Recent papers in Deep venous thrombosis (DVT)
Deep venous thrombosis (DVT) in an amputated stump is potentially life-threatening but rarely diagnosed and there are limited data in sub-Saharan Africa. This is aimed at demonstrating an additional vascular risk in patients with lower... more
Deep venous thrombosis (DVT) in an amputated stump is potentially life-threatening but rarely diagnosed and there are limited data
in sub-Saharan Africa. This is aimed at demonstrating an additional vascular risk in patients with lower limb amputation and diabetes.
A 74-year-old man who had a right above knee amputation done on account of grade 5 right diabetic foot with post-operative prophylactic anticoagulation. Doppler ultrasound done before the surgery showed bilateral multiple lower limb arteries atherosclerosis
but no evidence of deep venous thrombosis. He was discharged home on Zimmer frame. Three months after, he was noticed to
have differential swelling of the right amputation stump. Thigh circumference measured at 15 cm below the anterior superior iliac
spine was 55 cm and 50 cm on the right and left respectively there was but no differential warmth or tenderness. The vital signs were
relatively stable. Doppler ultrasound scan of the lower limbs showed an echogenic thrombus in the right deep femoral vein. He was
commenced on therapeutic dose of subcutaneous enoxaparin. DVT in an amputated stump is uncommonly encountered. It may not
have classical clinical findings. Poor mobility and pooling of venous blood in the amputated stump are some of the risk factors that
have been reported. DVT in an amputated stump in a patient with diabetes is rare and may not present classically. It may be one of
the potential reasons for the increased mortality after lower limb amputation.
in sub-Saharan Africa. This is aimed at demonstrating an additional vascular risk in patients with lower limb amputation and diabetes.
A 74-year-old man who had a right above knee amputation done on account of grade 5 right diabetic foot with post-operative prophylactic anticoagulation. Doppler ultrasound done before the surgery showed bilateral multiple lower limb arteries atherosclerosis
but no evidence of deep venous thrombosis. He was discharged home on Zimmer frame. Three months after, he was noticed to
have differential swelling of the right amputation stump. Thigh circumference measured at 15 cm below the anterior superior iliac
spine was 55 cm and 50 cm on the right and left respectively there was but no differential warmth or tenderness. The vital signs were
relatively stable. Doppler ultrasound scan of the lower limbs showed an echogenic thrombus in the right deep femoral vein. He was
commenced on therapeutic dose of subcutaneous enoxaparin. DVT in an amputated stump is uncommonly encountered. It may not
have classical clinical findings. Poor mobility and pooling of venous blood in the amputated stump are some of the risk factors that
have been reported. DVT in an amputated stump in a patient with diabetes is rare and may not present classically. It may be one of
the potential reasons for the increased mortality after lower limb amputation.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to... more
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.