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DOI: 10.1055/s-0031-1273093
Dexter versus Sinister Deep Vein Thrombosis: Which Is the More Sinister? Findings from the NRITLD DVT Registry
Publication History
Publication Date:
31 March 2011 (online)
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ABSTRACT
Deep vein thrombosis (DVT) is a major health problem. Despite the wealth of studies on its epidemiology, few have described the thrombus sidedness and particularly the association of thrombus sidedness with clinical presentation and subsequent complications. This article reviews current knowledge regarding this topic and in light of recent data from a large prospective study. This is the first report from the prospective National Research Institute of Tuberculosis and Lung Disease DVT registry. Patients with ultrasound-confirmed symptomatic DVT were enrolled, and thrombus sidedness was investigated in each case. Computed tomography pulmonary angiography was used to diagnose coexisting pulmonary embolism (PE) in DVT patients with suggestive symptoms. Embolic burden score was calculated for those with PE. From the total of 100 patients, 45 had left-sided DVT, 41 had right-sided DVT, and 14 had bilateral DVT. Presenting symptoms and comorbidities were comparable, except for cancer, which was more common in those with right-sided involvement (either right-sided or bilateral DVT; p = 0.004). Compared with those with left-sided DVT, PE happened more frequently in right-sided DVT patients. Right-sided DVT patients also had a higher rate of massive PE (p = 0.03) and a greater mean embolic burden (13.32 ± 1.63 versus 6.05 ± 1.06; p = 0.001). These findings support raised awareness for global reconsideration of the assumption of complete identicalness of right-sided and left-sided DVT. Although future studies are needed to better elucidate epidemiological and prognostic differences based on the thrombus sidedness, our preliminary findings suggest that the two are not completely identical and right-sided DVT might be more ominous.
KEYWORDS
Venous thrombosis - thrombus sidedness - lower extremity
REFERENCES
- 1 Fowkes F JI, Price J F, Fowkes F GR. Incidence of diagnosed deep vein thrombosis in the general population: systematic review. Eur J Vasc Endovasc Surg. 2003; 25 (1) 1-5
- 2 Huisman M V, Büller H R, ten Cate J W et al.. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest. 1989; 95 (3) 498-502
- 3 Monreal M, Ruíz J, Olazabal A, Arias A, Roca J. Deep venous thrombosis and the risk of pulmonary embolism. A systematic study. Chest. 1992; 102 (3) 677-681
- 4 Goldhaber S Z, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 353 (9162) 1386-1389
- 5 Kerr T M, Cranley J J, Johnson J R et al.. Analysis of 1084 consecutive lower extremities involved with acute venous thrombosis diagnosed by duplex scanning. Surgery. 1990; 108 (3) 520-527
- 6 May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957; 8 (5) 419-427
- 7 Virchow R. Ueber die Erweiterung kleinerer Gefäfse. Arch Pathol Anat Physiol Klin Med. 1851; 3 427-462
- 8 Ouriel K, Green R M, Greenberg R K, Clair D G. The anatomy of deep venous thrombosis of the lower extremity. J Vasc Surg. 2000; 31 (5) 895-900
- 9 Markel A, Manzo R A, Bergelin R O, Strandness Jr D E. Pattern and distribution of thrombi in acute venous thrombosis. Arch Surg. 1992; 127 (3) 305-309
- 10 Lee H C, Liao W B, Bullard M J, Hsu T S. Deep venous thrombosis in Taiwan. Jpn Heart J. 1996; 37 (6) 891-896
- 11 Sun K K, Wang C, Guli X T, Luo Q. Risk factors and clinical features of deep venous thrombosis: a report of 388 cases [in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi. 2004; 27 (11) 727-730
- 12 Labropoulos N, Webb K M, Kang S S et al.. Patterns and distribution of isolated calf deep vein thrombosis. J Vasc Surg. 1999; 30 (5) 787-791
- 13 Cronin C G, Lohan D G, Keane M, Roche C, Murphy J M. Prevalence and significance of asymptomatic venous thromboembolic disease found on oncologic staging CT. AJR Am J Roentgenol. 2007; 189 (1) 162-170
- 14 Laporte S, Tardy B, Quenet S et al.. The location of deep-vein thrombosis as a predictive factor for recurrence and cancer discovery after proximal deep-vein thrombosis. Haematologica. 2003; 88 ELT08
- 15 Segal J B, Eng J, Tamariz L J, Bass E B. Review of the evidence on diagnosis of deep venous thrombosis and pulmonary embolism. Ann Fam Med. 2007; 5 (1) 63-73
- 16 Araoz P A, Gotway M B, Harrington J R, Harmsen W S, Mandrekar J N. Pulmonary embolism: prognostic CT findings. Radiology. 2007; 242 (3) 889-897
- 17 von Elm E, Altman D G, Egger M, Pocock S J, Gøtzsche P C, Vandenbroucke J P. STROBE Initiative . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61 (4) 344-349
- 18 Fard M N, Mostaan M, Anaraki M R. Utility of lower-extremity duplex sonography in patients with venous thromboembolism. J Clin Ultrasound. 2001; 29 (2) 92-98
- 19 James A H, Tapson V F, Goldhaber S Z. Thrombosis during pregnancy and the postpartum period. Am J Obstet Gynecol. 2005; 193 (1) 216-219
- 20 Ginsberg J S, Brill-Edwards P, Burrows R F et al.. Venous thrombosis during pregnancy: leg and trimester of presentation. Thromb Haemost. 1992; 67 (5) 519-520
- 21 Franchini M, Montagnana M, Favaloro E J, Lippi G. The bidirectional relationship of cancer and hemostasis and the potential role of anticoagulant therapy in moderating thrombosis and cancer spread. Semin Thromb Hemost. 2009; 35 (7) 644-653
- 22 Piccioli A, Falanga A, Baccaglini U, Marchetti M, Prandoni P. Cancer and venous thromboembolism. Semin Thromb Hemost. 2006; 32 (7) 694-699
- 23 Goldberg R J, Seneff M, Gore J M et al.. Occult malignant neoplasm in patients with deep venous thrombosis. Arch Intern Med. 1987; 147 (2) 251-253
- 24 Lippi G, Franchini M, Biasiutti C, Dellagiacoma G, Salvagno G L, Guidi G C. Increased D-dimer value and occult cancer in the absence of detectable thrombosis. Haematologica. 2007; 92 (4) e53-e55
- 25 Imberti D, Agnelli G, Ageno W MASTER Investigators et al. Clinical characteristics and management of cancer-associated acute venous thromboembolism: findings from the MASTER Registry. Haematologica. 2008; 93 (2) 273-278
- 26 Trujillo-Santos J, Prandoni P, Rivron-Guillot K RIETE Investigators et al. Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry. J Thromb Haemost. 2008; 6 (2) 251-255
- 27 Douketis J D, Crowther M A, Foster G A, Ginsberg J S. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis?. Am J Med. 2001; 110 (7) 515-519
- 28 Seinturier C, Bosson J L, Colonna M, Imbert B, Carpentier P H. Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study. J Thromb Haemost. 2005; 3 (7) 1362-1367
- 29 Samuels M A, King M E, Balis U. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 31-2002. A 61-year-old man with headache and multiple infarcts. N Engl J Med. 2002; 347 (15) 1187-1194
- 30 Seruga B, Zhang H B, Bernstein L J, Tannock I F. Cytokines and their relationship to the symptoms and outcome of cancer. Nat Rev Cancer. 2008; 8 (11) 887-899
- 31 Khasabov S G, Hamamoto D T, Harding-Rose C, Simone D A. Tumor-evoked hyperalgesia and sensitization of nociceptive dorsal horn neurons in a murine model of cancer pain. Brain Res. 2007; 1180 7-19
- 32 Chan W S, Spencer F A, Ginsbergm J S. Anatomic distribution of deep vein thrombosis in pregnancy. CMAJ. 2010; 182 (7) 657-660
- 33 Kucher N, Tapson V F, Goldhaber S Z, Comm D FS. DVT FREE Steering Committee . Risk factors associated with symptomatic pulmonary embolism in a large cohort of deep vein thrombosis patients. Thromb Haemost. 2005; 93 (3) 494-498
- 34 Heit J A, Silverstein M D, Mohr D N, Petterson T M, O'Fallon W M, Melton III L J. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med. 1999; 159 (5) 445-453
Behnood BikdeliM.D.
Cardiovascular Department, National Research Institute of Tuberculosis and Lung Disease
Darabad, Tehran, Iran
Email: bbikdeli@sbmu.ac.ir; behnood61@yahoo.com