Talk:Venous thrombosis

Is

Is this the same as DVT? (Deep vein thrombosis) that killed some long-haul plane passengers some months ago? Tenbaset 23:36 Apr 15, 2003 (UTC)

A deep venous thrombosis is one kind of venous thrombosis, distinguished by location from another kind, superficial venous thrombosis. Usually, DVT refers to a venous thrombosis occurring in the pelvic veins or deep veins of the leg. And yes, DVTs predispose to pulmonary embolism, which kills people after long trips (on planes, busses, etc). Superficial venous thromboses don't. -- Someone else 23:42 Apr 15, 2003 (UTC)

Merge?

What's the difference between Venous thrombosis and Phlebothrombosis? WhatamIdoing (talk) 02:43, 29 January 2008 (UTC)

Good question. Biosthmors (talk) 21:02, 10 August 2012 (UTC)

Risks section

I wanted to add "IV drug abuse" to the list of risks, but am unsure which subcategory I should place it in.

66.41.0.174 (talk) 00:14, 13 July 2008 (UTC)

That's a great question. Any time a needle goes into a vein, there's a small risk of a clot forming. So it's not just IVDU; it's also getting your cholesterol checked, or getting fluids by IV, or anything else that involves poking a hole in your vein. If you can find a way to phrase it, I'd put drug abuse in the same half-sentence with "medically necessary" injections, and file it under "Medical".

I wonder whether Thoracic outlet syndrome is on the list? It's an effective way to get a clot in your arm, but it's not very common. WhatamIdoing (talk) 06:30, 13 July 2008 (UTC)

Aspirin

Here we go again: what use is aspirin in the prevention of VTE? http://www3.interscience.wiley.com/journal/122381757/abstract JFW | T@lk 10:56, 2 July 2009 (UTC)

Extent predicts recurrence

doi:10.1111/j.1538-7836.2010.04022.x - PE carries threefold the risk of recurrence compared to DVT. JFW | T@lk 17:09, 17 February 2011 (UTC)

Factual errors reintroduced?

With this revert,[1] I think factual errors were reintroduced. For example, the study found harm, not benefit from mechanical measures. And the study only said heparain may reduce PE, not that "it does decrease the risk of pulmonary embolism". I am not sure why these deviations from the source are an improvement. Biosthmors (talk) 17:56, 4 January 2012 (UTC)

Yes good points. The harm with mechanical measure where only in those with stroke though, have changed to "may" from "dose"Doc James (talk · contribs · email) 18:12, 4 January 2012 (UTC)

Thanks. Biosthmors (talk) 18:37, 4 January 2012 (UTC)

The results do state that "When trials of medical patients and those with stroke were considered together (18 studies; 36,122 patients), heparin prophylaxis reduced the incidence of PE (OR, 0.70 [CI, 0.56 to 0.87]; absolute reduction, 3 events per 1000 patients treated [CI, 1 to 5 events]) ". Thus I think the term dose is appropriate as they did find that it does reduce PEs.Doc James (talk · contribs · email) 18:18, 4 January 2012 (UTC)

The first sentence in the data synthesis section notes statistical significance, but cautions of publication bias. Maybe that is why they chose the more cautious language when drawing their conclusions. Biosthmors (talk) 18:37, 4 January 2012 (UTC)

I currently think sticking with the authors' conclusions is best. Biosthmors (talk) 18:41, 4 January 2012 (UTC)

This paper by Cochrane states their is a decrease http://www.ncbi.nlm.nih.gov/pubmed?term=19588346 Doc James (talk · contribs · email) 18:54, 4 January 2012 (UTC)

Present the two conclusions side by side? Biosthmors (talk) 19:00, 4 January 2012 (UTC)

They come to basically the same conclusions. Heparin reduces DVTs/PEs but increases bleeding and thus does not result in a mortality benefit. Cochrane say does reduce PEs the 2011 says may. And of course Cochrane recommends and 2011 does not based on about the same evidence.Doc James (talk · contribs · email) 19:02, 4 January 2012 (UTC)

I removed the reduction in DVT statement as it wasn't in line with the 2011 source and here's the source that offered support: Alikhan, R (2009 Jul 8). "Heparin for the prevention of venous thromboembolism in general medical patients (excluding stroke and myocardial infarction)". Cochrane database of systematic reviews (Online) (3): CD003747. PMID 19588346. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Biosthmors (talk) 19:06, 11 January 2012 (UTC)

The Cochrane paper states "A significant risk reduction in deep vein thrombosis (DVT) by 60%" and Cochrane is one of the most respected sources. There is not one "main source". Thus returned. Doc James (talk · contribs · email) 19:26, 11 January 2012 (UTC)

But that contradicts the 2011 ACP review. Biosthmors (talk) 19:35, 11 January 2012 (UTC)

Noted in article.[2] Biosthmors (talk) 19:44, 11 January 2012 (UTC)

The 2011 paper is only for symptomatic DVTs while Cochrane implies DVTs in general.Doc James (talk · contribs · email) 20:02, 11 January 2012 (UTC)

Another paper

Qaseem, A (2011 Nov 1). "Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians". Annals of internal medicine. 155 (9): 625–32. PMID 22041951. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)Doc James (talk · contribs · email) 16:14, 30 January 2012 (UTC)

Thanks, it is cited once just for a minor purpose though. I'll try to expand the article with it. Biosthmors (talk) 16:23, 30 January 2012 (UTC)

Superficial venous thrombosis

There is some literature on superficial venous thromboses. For example: Décousus H, Bertoletti L, Frappé P, Becker F, Jaouhari AE, Mismetti P; et al. (2011). "Recent findings in the epidemiology, diagnosis and treatment of superficial-vein thrombosis". Thromb Res. 127 Suppl 3: S81-5. doi:10.1016/S0049-3848(11)70022-6. PMID 21262449. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) I guess the topic could warrant its own article. Biosthmors (talk) 20:27, 31 January 2012 (UTC)

Move to venous thromboembolism?

From working on DVT, I have noticed that the medical literature can use venous thrombosis as a short way of saying venous thromboembolism. I'm thinking this article should move to venous thromboembolism to narrow its focus. I think superficial vein thrombosis as a stub makes the transition make more sense. Maybe venous thrombosis can then become a disambiguation page that says it is a term for a blood clot in a vein and then gives three options: one for DVT, one for VTE, and one for superficial VT. Biosthmors (talk) 21:16, 10 August 2012 (UTC)

Controversies

doi:10.1111/bjh.12306 covers controversies in VTE. JFW | T@lk 13:09, 10 June 2013 (UTC)

NOACs

... cause slightly less bleeding doi:10.1111/jth.12485 (good secondary source). JFW | T@lk 17:39, 6 March 2014 (UTC)

Another meta-analysis showing same: doi:10.1182/blood-2014-04-571232 JFW | T@lk 22:34, 20 September 2014 (UTC)

Recurrence

doi:10.1111/jth.12914 - PEs recur as PEs (of which 27% fatal) while DVTs recur as DVTs, on the whole. Systematic review and meta-analysis. JFW | T@lk 08:57, 30 March 2015 (UTC)

Provocation

doi:10.1111/jth.13336 JFW | T@lk 13:33, 25 April 2016 (UTC)

Imaging

Reviewed doi:10.1111/jth.13403 JFW | T@lk 16:28, 28 September 2016 (UTC)

Other forms of venous thrombosis

We should be featuring a list of other forms of venous thrombosis. Every vein can thrombose, but there is a veritable list that probably belongs here. JFW | T@lk 21:27, 14 August 2019 (UTC)

✓ Done JFW | T@lk 22:04, 14 August 2019 (UTC)

ASH guideline suite

http://www.bloodadvances.org/content/2/22 JFW | T@lk 22:04, 14 August 2019 (UTC)

NICE NG158

Guideline updated here. Need to review references to CG144 and replace. JFW | T@lk 09:57, 5 May 2020 (UTC)

UEDVT in the lead

This was added to the lead: It is increasingly found in the deep veins of the arm, accounting for more than 10% of all deep vein thromboses.

Mostly placing here so the sources can be reviewed and incorporated in the article body. JFW | T@lk 21:51, 15 November 2020 (UTC)

Cancer screening

At some point we need to discuss the need for cancer screening in those with unprovoked VTE. NICE NG158 has updated guidance that this should not be done in the absence of symptoms or suggestive physical findings. Risk scores perform poorly and should not be used doi:10.1111/jth.15001 JFW | T@lk 21:57, 15 November 2020 (UTC)

DOACs for cancer-associated thrombosis

doi:10.1182/blood.2020005819 JFW | T@lk 21:58, 15 November 2020 (UTC)

The Cochrane review for primary prevention has been updated: doi:10.1002/14651858.cd008500.pub5. Glafoululle des Alpes added a summary but it contained errors. JFW | T@lk 09:46, 7 February 2021 (UTC)

Thanks for reviewing my updates, I am eager to learn to ensure I contribute positively to safer, and particularly, more efficient medicine. In this particular case of an updated Cochrane review (Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy), it seems that the the evidence of the risk for major bleeding (after using either Xa inhibitor or LMWH) has increased quite significantly and that this is necessary to be mentioned. Glafoululle des Alpes (talk • contribs) 22:20, 8 February 2021 (UTC)

Hi, I missed this in November. This is the edit that was reverted. "For people undergoing chemotherapy for cancer and who walk, direct oral anticoagulants (preferably LMWH) decrease the risk of VTE, but increases the risk of major bleeding" from 2021 version of the review. @Jfdwolff and Glafoululle des Alpes: how do you feel about the following edit: "For people undergoing chemotherapy for cancer that do not require a hospital stay (those undergoing ambulatory care), there is low certainty evidence to suggest that treatment with direct factor Xa inhibitors may help prevent symptomatic VTEs, however this treatment approach may also lead to an increase in the risk of a major bleed compared to a placebo medication. There is stronger evidence to suggest that LMWH helps prevent symptomatic VTE, however this treatment approach also comes with a higher risk of a major bleed compared to a placebo medication or no treatments to prevent VTE." JenOttawa (talk) 15:32, 20 April 2022 (UTC)

JenOttawa Seems reasonable, but it would be helpful if we also presented current clinical guidelines. Primary prophylaxis is only routinely used in very specific situations (e.g. thalidomide therapy in myeloma), and the published tools for predicting risk perform very poorly. JFW | T@lk 22:21, 20 April 2022 (UTC)

I agree. I added a sentence from The American Society of Hematology earlier today in this edit. I will make my above edit and try to merge both into something more readable. If you know of any other clinical practice guidelines please do share. I think that I will share the clinical practice guideline first and then share evidence about effectiveness/risks. Thanks for reviewing @Jfdwolff:! JenOttawa (talk) 22:52, 20 April 2022 (UTC)

I tried to re-work the entire prevention section. It would be great if we could include a section on what you mentioned- that published tools for determining risk of an event are not reliable. If someone sees this and posts the source here I can try to integrate. I have to step away now (dinner time :) ) but if anyone has suggestions to further improve this section please do jump in and keep the momentum! I just realized that this post was actually from 2020! Thanks again for flagging this on the talk page. JenOttawa (talk) 23:12, 20 April 2022 (UTC)

"Thromboembolic" listed at Redirects for discussion

An editor has identified a potential problem with the redirect Thromboembolic and has thus listed it for discussion. This discussion will occur at Wikipedia:Redirects for discussion/Log/2022 January 13#Thromboembolic until a consensus is reached, and readers of this page are welcome to contribute to the discussion. Asmodea Oaktree (talk) 13:44, 13 January 2022 (UTC)