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Acquired Risk Factors for Deep-Vein Thrombosis in Symptomatic Outpatients

Acquired Risk Factors for Deep-Vein Thrombosis in Symptomatic Outpatients Abstract Background: Epidemiologic studies on deep-vein thrombosis (DVT) have been mainly confined to the inpatient population. The aim of this study was to investigate the association between DVT and acquired risk factors in a large cohort of outpatients with clinically suspected DVT. Methods: Consecutive outpatients with clinically suspected DVT were enrolled in the study. Before objective testing, all patients were interviewed by a trained physician for the presence of risk factors for DVT development. Subsequently, the presence or absence of DVT was assessed with venography. Results: Approximately 50% of cases of DVT were considered to be secondary to a major risk factor (immobilization, trauma, and/or recent surgery). Among additional risk factors, only increased age (over 60 years), male gender, malignant neoplasm, heart failure, systemic lupus erythematosus, and arteriopathy were independently associated with the risk of acute DVT. Conclusion: Major risk factors for venous thromboembolism are a common cause of DVT among symptomatic outpatients; therefore, the usefulness of extending DVT prophylaxis in the outpatient setting should be tested. The role of additional risk factors in the development of DVT needs to be established by properly designed studies.(Arch Intern Med. 1994;154:164-168) References 1. Thomas DP. Pathogenesis of venous thrombosis . In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice . Philadelphia, Pa: JB Lippincott; 1987:820-830. 2. Carter C, Gent M. The epidemiology of venous thrombosis . In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice . Philadelphia, Pa: JB Lippincott; 1987:805-819. 3. Sevitt S, Gallagher NG. Venous thrombosis and pulmonary embolism: a clinicopathological study in injured and burned patients . Br J Surg. 1961;48:475-482.Crossref 4. Walsh JJ, Bonnar J, Wright FW. A study of pulmonary embolism and deep leg vein thrombosis after major gynaecology surgery using labelled fibrinogenphlebography and lung scanning . J Obstet Gynaecol Br Commonw . 1974;81: 311-316.Crossref 5. Anderson GM, Hull E. The effect of dicumarol upon the mortality and incidence of thromboembolic complications in congestive heart failure . Am Heart J . 1950; 39:697.Crossref 6. Harvey WP, Finch CA. Dicumarol prophylaxis in thromboembolic disease in congestive heart failure . N Engl J Med . 1950;242:208.Crossref 7. Rosemberg L, Evans M, Pollak AV. Prophylaxis of post-operative leg vein thrombosis by low dose subcutaneous heparin or preoperative calf muscle stimulation: a controlled clinical trial . BMJ . 1975;1:649-651.Crossref 8. Pineo GF, Brain MC, Gallus AS, et al. Tumors, mucus production and hypercoagulability . Ann N Y Acad Sci . 1974;230:262-270.Crossref 9. Kakkar VV, Howe CT, Nicolaides AN, et al. Deep vein thrombosis of the leg: is there a 'high risk' group? Am J Surg . 1970;120:527-531.Crossref 10. Nicolaides AN, Irving D. Clinical factors and the risk of deep venous thrombosis . In: Nicolaides AN, ed. Thromboembolism Etiology: Advances in Prevention and Management . Baltimore, Md: University Park Press; 1975:194-214. 11. Anderson FA, Wheeler B, Goldberg RJ, Hosmer DW, Forcier A. The prevalence of risk factors for venous thromboembolism among hospital patients . Arch Intern Med . 1992;152:1660-1664.Crossref 12. Kierkegaard A. Incidence of acute deep vein thrombosis in two district: a phlebographic study . Acta Chir Scand . 1980;146:267-269. 13. Royal College of General Practitioners. Oral contraception and thromboembolic disease . J R Coll Gen Pract . 1967;13:167-179. 14. Vessey MP. Female hormones and vascular disease . Br J Fam Plan . 1980;6 ( (suppl) ):1-12. 15. Thorogood M, Mann J, Murphy M, Vessey M. Risk factors for fatal venous thromboembolism in young women . Int J Epidemiol . 1992;21:48-52.Crossref 16. Vandenbroucke JP. Prospective or retrospective . BMJ . 1991;302:249-250.Crossref 17. Prandoni P, Lensing AWA, Huisman MV, et al. A new computerized impedance plethysmography . Thromb Haemost . 1991;65:229-232. 18. Lensing AWA, Prandoni P, Brandjes D, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography . N Engl J Med . 1989;320:342-346.Crossref 19. Prandoni P, Lensing AWA, Büller HR, et al. Effectiveness of fixed-dose subcutaneous low molecular heparin versus adjusted-dose intravenous heparin in the treatment of proximal deep-vein thrombosis . Lancet . 1992;339:441-445.Crossref 20. Lensing AWA, Prandoni P, Büller HR, et al. Lower extremity venography with iohexol: results and complications . Radiology . 1990;177:503-506.Crossref 21. Lensing AWA, Büller HR, Prandoni P, et al. Contrast venography, the gold standard for the diagnosis of deep vein thrombosis . Thromb Haemost . 1992;67: 8-12. 22. Gibs NM. Venous thrombosis of the lower limbs with particular reference to bed-rest . Br J Surg . 1957;45:209.Crossref 23. Heijboer H, Brandjes DPM, Büller HR, et al. Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep vein thrombosis . N Engl J Med . 1990;323:1512-1516.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Acquired Risk Factors for Deep-Vein Thrombosis in Symptomatic Outpatients

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420020066008
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Epidemiologic studies on deep-vein thrombosis (DVT) have been mainly confined to the inpatient population. The aim of this study was to investigate the association between DVT and acquired risk factors in a large cohort of outpatients with clinically suspected DVT. Methods: Consecutive outpatients with clinically suspected DVT were enrolled in the study. Before objective testing, all patients were interviewed by a trained physician for the presence of risk factors for DVT development. Subsequently, the presence or absence of DVT was assessed with venography. Results: Approximately 50% of cases of DVT were considered to be secondary to a major risk factor (immobilization, trauma, and/or recent surgery). Among additional risk factors, only increased age (over 60 years), male gender, malignant neoplasm, heart failure, systemic lupus erythematosus, and arteriopathy were independently associated with the risk of acute DVT. Conclusion: Major risk factors for venous thromboembolism are a common cause of DVT among symptomatic outpatients; therefore, the usefulness of extending DVT prophylaxis in the outpatient setting should be tested. The role of additional risk factors in the development of DVT needs to be established by properly designed studies.(Arch Intern Med. 1994;154:164-168) References 1. Thomas DP. Pathogenesis of venous thrombosis . In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice . Philadelphia, Pa: JB Lippincott; 1987:820-830. 2. Carter C, Gent M. The epidemiology of venous thrombosis . In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice . Philadelphia, Pa: JB Lippincott; 1987:805-819. 3. Sevitt S, Gallagher NG. Venous thrombosis and pulmonary embolism: a clinicopathological study in injured and burned patients . Br J Surg. 1961;48:475-482.Crossref 4. Walsh JJ, Bonnar J, Wright FW. A study of pulmonary embolism and deep leg vein thrombosis after major gynaecology surgery using labelled fibrinogenphlebography and lung scanning . J Obstet Gynaecol Br Commonw . 1974;81: 311-316.Crossref 5. Anderson GM, Hull E. The effect of dicumarol upon the mortality and incidence of thromboembolic complications in congestive heart failure . Am Heart J . 1950; 39:697.Crossref 6. Harvey WP, Finch CA. Dicumarol prophylaxis in thromboembolic disease in congestive heart failure . N Engl J Med . 1950;242:208.Crossref 7. Rosemberg L, Evans M, Pollak AV. Prophylaxis of post-operative leg vein thrombosis by low dose subcutaneous heparin or preoperative calf muscle stimulation: a controlled clinical trial . BMJ . 1975;1:649-651.Crossref 8. Pineo GF, Brain MC, Gallus AS, et al. Tumors, mucus production and hypercoagulability . Ann N Y Acad Sci . 1974;230:262-270.Crossref 9. Kakkar VV, Howe CT, Nicolaides AN, et al. Deep vein thrombosis of the leg: is there a 'high risk' group? Am J Surg . 1970;120:527-531.Crossref 10. Nicolaides AN, Irving D. Clinical factors and the risk of deep venous thrombosis . In: Nicolaides AN, ed. Thromboembolism Etiology: Advances in Prevention and Management . Baltimore, Md: University Park Press; 1975:194-214. 11. Anderson FA, Wheeler B, Goldberg RJ, Hosmer DW, Forcier A. The prevalence of risk factors for venous thromboembolism among hospital patients . Arch Intern Med . 1992;152:1660-1664.Crossref 12. Kierkegaard A. Incidence of acute deep vein thrombosis in two district: a phlebographic study . Acta Chir Scand . 1980;146:267-269. 13. Royal College of General Practitioners. Oral contraception and thromboembolic disease . J R Coll Gen Pract . 1967;13:167-179. 14. Vessey MP. Female hormones and vascular disease . Br J Fam Plan . 1980;6 ( (suppl) ):1-12. 15. Thorogood M, Mann J, Murphy M, Vessey M. Risk factors for fatal venous thromboembolism in young women . Int J Epidemiol . 1992;21:48-52.Crossref 16. Vandenbroucke JP. Prospective or retrospective . BMJ . 1991;302:249-250.Crossref 17. Prandoni P, Lensing AWA, Huisman MV, et al. A new computerized impedance plethysmography . Thromb Haemost . 1991;65:229-232. 18. Lensing AWA, Prandoni P, Brandjes D, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography . N Engl J Med . 1989;320:342-346.Crossref 19. Prandoni P, Lensing AWA, Büller HR, et al. Effectiveness of fixed-dose subcutaneous low molecular heparin versus adjusted-dose intravenous heparin in the treatment of proximal deep-vein thrombosis . Lancet . 1992;339:441-445.Crossref 20. Lensing AWA, Prandoni P, Büller HR, et al. Lower extremity venography with iohexol: results and complications . Radiology . 1990;177:503-506.Crossref 21. Lensing AWA, Büller HR, Prandoni P, et al. Contrast venography, the gold standard for the diagnosis of deep vein thrombosis . Thromb Haemost . 1992;67: 8-12. 22. Gibs NM. Venous thrombosis of the lower limbs with particular reference to bed-rest . Br J Surg . 1957;45:209.Crossref 23. Heijboer H, Brandjes DPM, Büller HR, et al. Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep vein thrombosis . N Engl J Med . 1990;323:1512-1516.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 24, 1994

References