Am J Med. 2020 Dec 11:S0002-9343(20)31111-6. doi: 10.1016/j.amjmed.2020.11.013. Online ahead of print.
ABSTRACT
BACKGROUND: Whether deep venous thrombosis involving the pelvic veins or inferior vena cava is associated with higher in-hospital mortality or higher prevalence of in-hospital pulmonary embolism than proximal or distal lower extremity deep venous thrombosis is not known.
METHODS: This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016, 2017. Patients hospitalized with a primary diagnosis of deep venous thrombosis at identified locations were identified by International Classification of Diseases-10-Clinical Modification codes.
RESULTS: In-hospital all-cause mortality with deep venous thrombosis involving the inferior vena cava in patients treated only with anticoagulants was 45 of 2045 (2.2%) vs 80 of 10,545 (0.8%) with pelvic vein deep venous thrombosis (p<0.0001), 710 of 103,810 (0.7%) with proximal deep venous thrombosis (p<0.0001) and 45 of 23,170 (0.2%) with distal deep venous thrombosis (p<0.0001). Mortality with anticoagulants was similar with pelvic vein deep venous thrombosis and proximal lower extremity deep venous thrombosis, 0.8% and 0.7% (p=0.39). Lower mortality was shown with pelvic vein deep venous thrombosis treated with thrombolytics than with anticoagulants, 0 of 4,150 (0%) vs 80 of 10,545 (0.8%)(p<0.0001). In-hospital pulmonary embolism occurred in 11% to 23%, irrespective of the site of deep venous thrombosis. Patients with distal lower extremity and proximal lower extremity deep venous thrombosis had the highest incidence of in-hospital pulmonary embolism.
CONCLUSION: Patients with deep venous thrombosis involving the inferior vena cava had higher in-hospital mortality than patients with deep venous thrombosis at other locations. Pelvic vein deep venous thrombosis did not result in higher mortality or more in-hospital pulmonary embolism than proximal lower extremity deep venous thrombosis. The incidence of in-hospital pulmonary embolism was considerable with deep venous thrombosis at all sites.
PMID:33316253 | DOI:10.1016/j.amjmed.2020.11.013