Management and outcomes of calf deep vein thrombosis in patients with contraindication to full anticoagulation due to bleeding.

Autor:	Elmi G; Ultrasound Program, Medical Department, Maggiore Hospital, AUSL Bologna, Bologna, Italy - elmigiovanna@gmail.com., Allegri D; Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy., Aluigi L; Unit of Angiology, Villalba Clinic, Bologna, Italy., Antignani PL; Vascular Centre, Nuova Villa Claudia Clinic, Rome, Italy., Aspide R; Anesthesia and Intensive Care Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy., Camaggi V; Ultrasound Program, Medical Department, Maggiore Hospital, AUSL Bologna, Bologna, Italy., DI Giulio R; Ultrasound Program, Medical Department, Maggiore Hospital, AUSL Bologna, Bologna, Italy., Domanico A; Ultrasound Program, Medical Department, Maggiore Hospital, AUSL Bologna, Bologna, Italy., Rinaldi ER; Ultrasound Program, Medical Department, Maggiore Hospital, AUSL Bologna, Bologna, Italy., Martignani A; Ultrasound Program, Medical Department, Maggiore Hospital, AUSL Bologna, Bologna, Italy., Palareti G; Arianna Anticoagulation Foundation, Bologna, Italy.
Jazyk:	angličtina
Zdroj:	International angiology : a journal of the International Union of Angiology [Int Angiol] 2023 Jun; Vol. 42 (3), pp. 229-238. Date of Electronic Publication: 2023 Jan 26.
DOI:	10.23736/S0392-9590.23.04947-7
Abstrakt:	Background: This prospective observational study was aimed at assessing early outcomes of inpatients with isolated distal deep vein thrombosis (IDDVT) and coexisting bleeding. Methods: Patients received enoxaparin 4000 units daily or intermediate doses, and ultrasound surveillance (US). Primary outcomes were extension to the popliteal vein (PDVT) or symptomatic pulmonary embolism (PE), bleeding complications during the treatment and the composite of PDVT and bleeding complications. Secondary outcomes were recurrent IDDVTs and death. Results: 90/95 patients completed the study period (30 days). PDVT occurred in 2/41 (4.9%) and in 3/45 (6.7%) subjects receiving enoxaparin 4000 units and intermediate doses respectively (OR 1.39; 95% CI: 0.22-11; P=0.72). PE occurred in only one of the 4 untreated subjects (25% vs. 0 patients taking enoxaparin 4000 units or intermediate doses; P=1.0). Recurrent IDDVTs occurred in 29 subjects (32.2%), more frequently during enoxaparin 4000 (19/29, 65.5%). Four patients died (4.4%). Bleeding complications occurred in 8 subjects (8.9%), all treated with intermediate doses (0 vs. 17.8%; P=1.0). Enoxaparin 4000 units significantly reduced the risk of the composite outcome compared with higher doses (4.9% vs. 24.4%; OR 6.31; 95% CI: 1.56-42.65; P=0.02). Major trauma significantly increased the risk of PDVT (OR 20.92; 95% CI: 2.82-427.51, P=0.01; logistic regression P=0.01). Patients with major trauma are also at increased bleeding risk (OR 5; 95% CI: 1.06-23.76, P=0.04; logistic regression P=0.03). Conclusions: Enoxaparin 4000 units daily, supported by US, may be an option for selected patients.
Databáze:	MEDLINE
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