ALBERT

Description: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common clinical problem, associated with a significant mortality and morbidity. Hence, accurate diagnosis and appropriate treatment are essential for patients presenting with suspected VTE. Unfortunately, the diagnosis of VTE is challenging in routine practice because of the nonspecific signs and symptoms of this disease. A large number of epidemiologic studies have focused on VTE, contributing to better understanding of this disease and improving its management. Demonstrated risk factors for VTE have been included into clinical prediction rules derived to help physician identify patients that should be referred for objective diagnostic tests. Over the past decade, the extensive use of diagnostic tests combined with the recent advances in imaging technology have resulted in more frequent diagnosis and treatment of early presentation of VTE, including isolated distal DVT or isolated PE. However the clinical signification of various VTE presentations remains unclear, and knowledge on epidemiology of VTE needs to be improve. Therefore we prospectively investigated the relative frequency and risk factors of isolated distal DVT, proximal DVT, PE with DVT and without DVT. Between November 2004 and January 2006, all patients over 18 years old who were referred to 359 french board certified vascular physicians for a clinical suspicion of VTE were included. VTE presentations were categorized using validated clinical decision rules and objective tests including ultrasonography, lung scan and helical CT scan. Subjects without an objectively confirmed diagnosis of VTE were used as controls. We performed multivariate analysis of risk factors for each type of VTE. 8256 patients entered the study, among which 7532 were analysed. The median age for all patients was 65 years (49–77 years), 2923 (39%) were men, 2925 were inpatients (39%), and 1884 (25%) had a previous history of VTE. 933 had isolated distal DVT (12%), 710 proximal DVT (9.4%), 426 PE with DVT (5.7%), 148 PE without DVT (2.0%) and 5315 had no VTE (70.6%). Classically risk factors were comparable for all different types of DVT (distal, proximal, or associated with PE). Curiously, risk factors for isolated pulmonary embolism are opposite to those for DVT-associated PE. Specially isolated PE was not associated with age (〉 75y, OR 1.2 [0.7–2.1, p 0.58), family history of VTE (OR 0.7 [0.4–1.3, p 0.26, bed confinement (OR 0.6[0.4–1.1, p 0.1),plaster (OR 0.3 [0.04–2.5, p 0.28), or acute respiratory or cardiac failure (OR 1.8 [0.9–3.3], p 0.07). Only personnal history of VTE (OR 1.7 [1.1–2.6], recent surgery (OR 1.7 [1.0–3.0], cancer [OR 1.7 [1.1–2.7, p 0.02) and contraceptive use (OR 6.3 [2.5–15.6] p〈 0.01) were shwon as risk factors for isolated PE. So this multicenter prospective cohort study shows heterogeneity in the risk factor profile between different forms of VTE encountered in daily practice, providing new insight in the epidemiology of this disease. Specifically, our study underlines the specific risk factors profile of isolated PE comparing to DVT-associated PE.

Description: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is associated with a significant mortality and life-long morbidity. A large number of studies have focused on VTE, contributing to better improving its management. Especially studies have provided accurate estimates of 3-month mortality rates for PE and have identified prognostic factors that may guide the physician’s initial treatment decision for these patients. However, improvements in the prevention of venous thromboembolism (VTE) and diagnosis have changed the epidemiology of VTE over the last twenty years. Advances in imaging technology have resulted in more frequent diagnosis and treatment of early presentation of VTE, including isolated distal DVT or isolated PE. However, the clinical signification and the prognosis of these forms of VTE are unknown. Therefore we prospectively investigated the 3-month overall for isolated distal DVT, proximal DVT, PE with DVT and PE without DVT, among a large in and out population study. Between November 2004 and January 2006, all patients over 18 years old who were referred to 359 french board-certified vascular physicians for a clinical suspicion of VTE were included. VTE presentations were categorized using validated clinical decision rules and objective tests including ultrasonography, lung scan and helical CT scan. Subjects without an objectively confirmed diagnosis of VTE were used as controls. All patients with confirmed VTE and a random sample of controls were followed-up at 3 months. We estimated 3 months survival for each type of VTE 8256 patients entered the study, among which 7532 were analysed. The median age for all patients was 65 years (49–77 years), 2923 (39%) were men, 2925 were inpatients (39%), and 1884 (25%) had a previous history of VTE. 933 had isolated distal DVT (12%), 710 proximal DVT (9.4%), 426 PE with DVT (5.7%), 148 PE without DVT (2.0%) and 5315 had no VTE (70.6%). Overall, 4290 patients were followed up at 3 months. At 3 months, VTE recurrence was not significantly different between the 5 groups of patients. By contrast, 95/2407 control patients (4%), 35/787 (4.4%) distal DVT, 48/598 (8%) proximal DVT, 48/371 (12.9%) PE with DVT, and 6/130 (4.6%) died. In multivariate analysis, the 3-months mortality adjusted hazard ratio [95% CI] was 1.1 [0.7–1.7] for distal DVT (P 0.59), 1.6 [1.1–2.3] for proximal DVT (P 0.013), 2.1 [1.4–3.0] for DVT-associated PE (p

Description: Abstract 5063 VTE is a multifactorial disease, but one of the strongest risk factor is age. Despite this high incidence, there is surprisingly little known about VTE in this population. So, based on the large OPTIMEV cohort study on VTE, the aim of this study was to focus on epidemiological information regarding VTE among old population. OPTIMEV was a multicentre prospective cohort study of patients referred for clinically suspected VTE throughout France. VTE presentations were categorized using objective tests including ultrasonography, lung scan and helical CT scan. Subjects without a confirmed diagnosis of VTE were used as controls. A total of 8256 patients were included in the OPTIMEV study, among which the aged study population (〉 75y) was 2149. The median age of the old group was 81 years (76 - 101 years). Among this cohort, a total of 655 patients (30.5%) were positive cases of VTE, including 203 isolated distal DVT (31%), and 452 (69%) proximal DVT +/- PE. Diagnosis of VTE was ruled out in 1494 patients (69.5%). To identify potential specific risk factors in older patients, we compared VTE positive aged patients to younger. For this purpose, we tested by logistic regression the interaction between age (more or less than 75) and risk factors. Personal or familial history of VTE, travel, cardiac or respiratory insufficiency were not specific of the difference in incidence of VTE in older compared to younger patients. Only male gender (OR 1.4, 95% CI 1.1 – 1.9), bed rest (OR 1.4, 95% CI 1.1 – 1.9), lower limb immobilization (OR 1.1, 95% CI 0.5 – 2.5 and surgery