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In-Hospital Risks and Management of Deep Venous Thrombosis According to Location of the Thrombus

  • Paul D Stein
    Correspondence
    Requests for reprints should be addressed to Paul D. Stein, MD, Michigan State University, College of Osteopathic Medicine, Department of Osteopathic Medical Specialties, 909 Wilson Road, B 305 West Fee, East Lansing, MI 48824.
    Affiliations
    Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing
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  • Fadi Matta
    Affiliations
    Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing
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  • Mary J. Hughes
    Affiliations
    Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing
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Published:December 11, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.11.013

      Abstract

      Background

      Whether deep venous thrombosis involving the pelvic veins or inferior vena cava is associated with higher in-hospital mortality or higher prevalence of in-hospital pulmonary embolism than proximal or distal lower extremity deep venous thrombosis is not known.

      Methods

      This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016, 2017. Patients hospitalized with a primary diagnosis of deep venous thrombosis at known locations were identified by International Classification of Diseases-10-Clinical Modification codes.

      Results

      In-hospital all-cause mortality with deep venous thrombosis involving the inferior vena cava in patients treated only with anticoagulants was 2.2% versus 0.8% with pelvic vein deep venous thrombosis (p<0.0001), 0.7% with proximal deep venous thrombosis (p<0.0001) and 0.2% with distal deep venous thrombosis (p<0.0001).  Mortality with anticoagulants was similar with pelvic vein deep venous thrombosis compared with proximal lower extremity deep venous thrombosis, 0.8% versus 0.7% (p=0.39). Lower mortality was shown with pelvic vein deep venous thrombosis treated with thrombolytics than with anticoagulants, 0% versus 0.8% (p<0.0001). In-hospital pulmonary embolism occurred in 11% to 23%, irrespective of the site of deep venous thrombosis.

      Conclusion

      Patients with deep venous thrombosis involving the inferior vena cava had higher in-hospital mortality than patients with deep venous thrombosis at other locations. Pelvic vein deep venous thrombosis did not result in higher mortality or more in-hospital pulmonary embolism than proximal lower extremity deep venous thrombosis.  The incidence of in-hospital pulmonary embolism was considerable with deep venous thrombosis at all sites.

      Keywords

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