Characteristics of isolated superficial vein thrombosis and diagnostic-therapeutic management in Spanish hospital emergency departments: the ALTAMIRA study
Por:
Chaib, FB, Hernandez, SJ, Navas, JMP, Mancilla, JC, Arias, LC, Loranca, MM, Gomez, AP, Marquez, AA, Polo, LP, Garrido-Lestache, AS, Lecumberri, R, Artacho, PR
Publicada:
1 dic 2021
Resumen:
Y Objectives. To describe the characteristics of patients with isolated lower-limb superficial vein thrombosis (SVT) treated in hospital emergency departments and to evaluate adherence to clinical practice guidelines on diagnosis (vein ultrasound imaging) and therapeutic management (start of anticoagulant therapy).
Methods. Retrospective cohort study in 18 Spanish emergency departments. We included all patients with a final emergency department diagnosis of lower-limb SVT aged 18 years or older between January 2016 and May 2017. Backward stepwise multiple logistic regression analysis was used to evaluate adherence to clinical practice guidelines on ordering vein ultrasound imaging and starting anticoagulant therapy.
Results. A total of 1166 patients were included. The mean patient age was 59.6 years, and 67.9% were women. About a quarter of the patients (24.4%) had a history of venous thromboembolic disease. Complications developed in 8.9% within 180 days: 4.6% experienced a recurrence and 3.6% progressed to SVT and 1.8% to deep vein thrombosis; pulmonary thromboembolism occurred in 0.9%. Hemorrhagic complications developed in 17 patients (1.5%). Sixteen patients (1.4%) died. Vein ultrasound imagine was ordered for 703 patients (60.3%). Anticoagulant agents were prescribed for 898 (77%) for a median period of 22 days. Variables associated with a decision to order anticoagulants were a history of venous thromboembolic disease (odds ratio [OR], 1.60; 95% CI, 1.12-2.30), varicose veins (OR, 1.40; 95% CI, 1.12-2.30); limb pain (OR, 1.44; 95% CI, 1.08-1.91); painful cord (OR, 1.30; 95% CI, 0.97-1.73); and availability of vein ultrasound images (OR, 1.60; 95% CI, 1.94-3.45).
Conclusions. Adherence to clinical practice guidelines for the diagnosis and treatment of isolated lower-limb SVT is low in Spanish emergency departments. Ultrasound imaging is not ordered for 1 out of every 2 to 3 patients, and anticoagulant treatment is not started in 1 out of 4 patients. There is great room for improvement.
Filiaciones:
Chaib, FB:
Complejo Asistencial Soria, Serv Urgencias, Madrid, Spain
Univ Valladolid, Fac Ciencias Salud, Valladolid, Spain
Hernandez, SJ:
Hosp Clin Barcelona, IDIBAPS, Area Urgencies, Barcelona, Spain
Navas, JMP:
Hosp Clin San Carlos, Serv Med Interne, Madrid, Spain
Mancilla, JC:
Gastro Obeso Ctr, Serv Med Interne, Guayaquil, Ecuador
Univ Catolica Santiago Guayaquil, Fac Ciencias Med, Guayaquil, Ecuador
Arias, LC:
Hosp Doce Octubre, Serv Urgencies, Madrid, Spain
Loranca, MM:
Hosp Univ Getafe, Serv Urgencies, Madrid, Spain
Gomez, AP:
Hosp Arnau de Vilanova Lliria, Serv Urgencias, Valencia, Spain
Marquez, AA:
Hosp Univ Nuestra Senora de Valme, Serv Urgencies, Seville, Spain
Polo, LP:
Hosp Santa Creu & Sant Pau, Serv Urgencies, Barcelona, Spain
Garrido-Lestache, AS:
Hosp Gen Albacete, Serv Urgencies, Albacete, Spain
Lecumberri, R:
Clin Univ Navarra, Serv Hematol, Navarra, Spain
CIBER CV, Navarra, Spain
Artacho, PR:
Clin Univ Navarra, Dept Med Interne, C Marquesado de Santa Marta 1, Madrid 28027, Spain
CIBERES, CIBER Enfermedades Resp, Madrid, Spain
Univ Navarra, Interdisciplinar Teragnosis & Radios INTRA Res Gr, Pamplona, Spain
Open Access
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