Výskyt a příčiny hluboké žilní trombózy dolních končetin v neselektované populaci interních pacientů

Cor Vasa 2005, 46(2)

The incidence and causes of deep vein thrombosis in an unselected population of medical patients

Ondřej Auzký^*, Jan Piťha: I. interní klinika, Fakultní Thomayerova nemocnice a IPVZ, Praha, Česká republika

Background:
A reliable diagnosis of deep venous thrombosis continues to be a challenge in everyday practice of almost all specialists in clinical medicine. In this observational study, we assessed the incidence and causes of deep vein thrombosis among unselected patients referred to an outpatient department of internal medicine responsible for a catchment area of Prague.

Methods:
Data of patients referred for examination at an internal outpatient department with pain, swelling or inflammation of the lower limb, were collected retrospectively. Patients with suspected deep vein thrombosis were examined using duplex ultrasound. The parameters of patients with a confirmed diagnosis of deep vein thrombosis included age, gender, localization, and probable cause of thrombosis.

Results:
Over a 12-month period, 9,489 patients were referred for examination at an outpatient internal department. In 475 patients, the presence of deep vein thrombosis in the lower limbs was suspected and duplex ultrasound was performed. D-dimer measurement was often omitted. In 175 patients, the diagnosis of deep venous thrombosis was confirmed by duplex ultrasound. Thrombosis was found in ileo-femoral veins in 23 patients, in femoro-popliteal veins in 63, and in popliteal veins in 26 patients. Isolated calf deep vein thrombosis was seen in 33 patients. In 30 patients, the diagnosis of extensive superficial thrombosis required anticoagulation treatment. In one patient, a diagnosis of deep vein thrombosis was established after repeat testing. The cause of thrombosis was established in 84 patients. The most common causes were neoplasm and trauma, followed by hormonal contraception and recent surgery. Deep vein thrombosis was also established in 8 out of 44 patients with a prior diagnosis of cellulitis; in 4 of these patients, femoral vein thrombosis was diagnosed. Compared with data reported by population-based studies, the incidence of deep vein thrombosis was 10-20 times more frequent than in the general population.

Conclusion:
Patients with suspected lower limb deep vein thrombosis comprised 5% of all medical patients referred to our outpatient department. In more than a third, vein thrombosis was confirmed by duplex ultrasound. Interestingly, deep vein thrombosis was quite often found in patients with lower limb cellulitis. Therefore, all of these patients should be evaluated for the presence of deep vein thrombosis.