Talk:Deep vein thrombosis/Archive 1

merge
I think the merge should have been done the other way. The term "deep vein thrombosis" is more common than "deep venous thrombosis"

google results: 633,000 for deep vein thrombosis 358,000 for deep venous thrombosis Nephron 01:08, 21 July 2005 (UTC)


 * The term in medical literature appears to be venous. JFW | T@lk  08:18, 21 July 2005 (UTC)


 * Based on what?
 * Pubmed results:
 * deep vein thrombosis: 31302
 * deep

Since an important audience is the less-technical, the common usage is more helpful. Technical readers, if they wish to consult Wikipedia, will be familiar with the more common term. —Preceding unsigned comment added by 67.101.66.55 (talk) 04:22, 30 November 2007 (UTC)

broken internal reference
"A careful history has to be taken considering risk factors (see below), " There's no subsection entitled 'Risk factors'. Could this be clarified or corrected?

Merging with thrombophlebitis
Of thrombophlebitis and deep vein thrombosis, the latter is the more serious and clinically relevant ones. Perhaps thrombophlebitis could be mentioned within deep vein thrombosis. Furthermore the content on thrombophlebitis is quite similar to the DVT article. Andrew73 12:33, 15 March 2006 (UTC)


 * I would say that they're distinct enough to justify separate articles (DVT is a spontaneous clot usually of the deep leg veins without inflammation, whereas thrombophlebitis is an inflamed clot usually of the superficial arm veins and usually after an IV). Under pressure, I suppose you could merge them into a general "Venous thrombotic conditions" page, but I don't think it makes sense to lump thrombophlebitis under DVT.  I do, however, agree with your other comments, and certainly cleaning up the content of thrombophlebitis might clear up some of the confusion.  — JVinocur (talk • contribs) 00:35, 10 May 2006 (UTC)
 * Fair enough, but agree that the content of thrombophlebitis needs to be more focused on the superficial variety as that's the context that it's generally used. Andrew73 14:53, 10 May 2006 (UTC)

Confusing terminology
Prophylaxis? Pathogenesis? This article is hard to follow for the average lay person such as myself. Can someone rewrite with sections named "Causes" and "Treatment"? -- Barrylb 19:51, 6 May 2006 (UTC)

Complications
A complications section could be useful.

Possible ambiguity
"In up to 25% of all hospitalized patients, there may be some form of DVT, which often remains clinically inapparent." This presumably refers to all patients hospitalized for whatever reason, not all patients hospitalized for suspected DVT - the sentence logic suggests it must be the the former, but it's such a large statistic that it took me a couple of rereads to understand. Moonlander69 23:17, 1 June 2007 (UTC)

Pregnancy
Can someone please explain the risks of using the prescibed medications for DVT and pregnancy. And if I have DVT due to an previous pregnancy what should I do when pregnant again whilst having DVT.

Too "doctorish" and uses too much lingo
I think the article is way too complex and written in the lingo that doctors use, probably BY a doctor or someone with a lot of medical training. That's OK if they have that training, but the thing is that most of us regular every-day people can't understand it because we don't have that training.


 * Which parts do you find confusing? I agree that we need to make this content accessible. JFW | T@lk  22:06, 22 November 2007 (UTC)

Cause / Etiology
Besides the grammar being incorrect in the following sentence, it also seems to reference research that claims the opposite of what it says here.

Other risk factors include advanced age, obesity, infection, immobilization, female sex, use of combined (estrogen-containing) forms of hormonal contraception, tobacco usage and air travel ("economy class syndrome", a combination of immobility and relative dehydration) are some of the better-known causes.and references Tsai A et a (2002). "Cardiovascular risk factors and venous thromboembolism incidence etc." .

In the abstract states: RESULTS: Cigarette smoking, hypertension, dyslipidemia, physical inactivity, and alcohol consumption were not associated with risk of VTE.

So although these are the "better-known" causes, that particular research found that it was not associated? Deadstar 13:30, 20 September 2007 (UTC)

--The "physical inactivity" relates to, e.g., how much exercise a person does per week. But "immobilization" refers to a person on a plane, etc. I suppose the two would overlap in the case of a sickly, bed-bound person. Kenmcl2 (talk) 05:44, 12 February 2009 (UTC)

Prophylaxis in medical patients
This is again supported by a systematic review: JFW |  T@lk  22:07, 22 November 2007 (UTC)

Tim Russert 1950 - 2008
Tim Russert from MSNBC Meet The Press just passed because of DVT. He collapsed on his job just after returning from Italy. AugustinMa (talk) 21:35, 13 June 2008 (UTC)

Long flight DVT prevention
Apparently, DVT is common after long flights (see Tim Russert above). Can the article add a section about prevention measure before, during and just after a long flight. Thanks AugustinMa (talk) 21:35, 13 June 2008 (UTC)

Inconsistency with published death rate
The article says: "DVTs occur in about 1 per 1000 persons per year. About 1-5% will die from the complications".

Yet this link http://ap.google.com/article/ALeqM5jLUJgboI9vrUtwrpyeOXkWNLOFOQD937BUI80 gives much higher death number: "the new surgeon general's campaign estimates that every year, between 350,000 and 600,000 Americans get one of these clots — and at least 100,000 of them die". It implies 15-30% death rate. —Preceding unsigned comment added by 97.116.53.139 (talk) 03:14, 16 September 2008 (UTC)
 * The number in the hundreds of thousands is for venous thromboembolism, which means DVT + PE. DVT alone doesn't kill. Biosthmors (talk) 19:40, 19 April 2012 (UTC)

LMWH better?
This is going to get interesting: LMWH therapy instead of warfarin was well tolerated but improved outcomes for postthrombotic syndrome and leg ulcers. JFW | T@lk  20:39, 28 July 2009 (UTC)

Diagnostic review
Br J Haem JFW |  T@lk  21:03, 28 July 2009 (UTC)

Material typo at Wells criteria
I'm not medical or nursing, so I have not corrected the wording at Wells criterion 8, which currently reads as "major surgery requiring regional or general anesthetic in past 4 weeks". Surely that is a typo for "12 weeks". Patrick Hamilton (talk)
 * Yep. Just read this comment and I happened to fix that yesterday as I was going through the diagnosis section. Biosthmors (talk) 19:38, 19 April 2012 (UTC)

Management--Anticoagulation
The last sentence is a fragment and it is unclear to me what exactly is not being disputed: "Despite the fact that no one disputes this, based on a meta analysis done by the Cochrane Collaboration where they found only one randomized trial of anti coagulation vs placebo in the treatment of VTE in which there was no significant difference between the two." —Preceding unsigned comment added by 64.149.52.154 (talk) 21:29, 18 May 2010 (UTC)
 * Rewritten. Biosthmors (talk) 19:41, 19 April 2012 (UTC)

Merge
Traveller's thrombosis should be merged her as it is basically a DVT due to flight. It is the same disease just has some social significance. Doc James (talk · contribs · email) 00:59, 29 May 2011 (UTC)

Image
I think the image used in the info box is confusing, mostly because of the arrow which appears to point to the thrombus on the leg rather than in it. Is there a similar image without the arrow, under which it could be written something along the lines of "DVTs typically present with a swollen painful calf, and comparing the calf diameters is an integral part of the diagnosing of the syndrome (see right calf)."--Mofs (talk) 21:15, 30 July 2011 (UTC)
 * Changed to in. I do have a copy of the image without the arrow but hopefully the text change clears things up.-- Doc James (talk · contribs · email) 21:49, 30 July 2011 (UTC)

Raising legs.
Please, please, please, someone knowledgeable on the mainstream medical approaches find references to my paragraph about raising legs. Raising legs does work and is often advised by medical practitioners. Anonywiki (talk) 21:54, 1 August 2011 (UTC)
 * I have never seen evidence for this. Would be happy to look at any you come across though. Review articles are best. Cheers Doc James  (talk · contribs · email) 15:19, 8 October 2011 (UTC)

I removed a few items from the lead
I removed them, as medical conditions which may lead to DVT because they aren't mentioned/sourced in the article. Instead, I added things that were sourced. Biosthmors (talk) 20:28, 27 February 2012 (UTC)
 * Nephrotic syndrome is now sourced and in the body of the article as a risk factor. Biosthmors (talk) 16:38, 20 March 2012 (UTC)

What do to with minor/rare forms/corollaries of DVT?
Phlegmasia alba dolens and phlegmasia cerulea dolens are currently discussed in the signs and symptoms section. May-Thurner syndrome and Paget-Schrötter disease are just mentioned in the pathophysiology section. And perhaps we're omitting another worthy manifestation. But I'm wondering if we should discuss all these four entities together, perhaps in the classification section. I'm thinking phlegmasia might be too infrequently mentioned/experienced to justify the word count it is currently given in the signs and symptoms section, although it does give characteristic signs. Biosthmors (talk) 17:43, 5 May 2012 (UTC)
 * I removed reference to alba per this discussion. Biosthmors (talk) 21:01, 4 September 2012 (UTC)

Internal inconsistency
I would like to suggest some modifications.

1. On the one hand: "Only pregnant women with strong risk factors for VTE are suggested to receive targeted (INR of 2.0 to 3.0) preventative measures." But on the other, by the end of the paragraph: "Warfarin, a common VKA, is known to have teratogenic effects on the fetus if administered in early pregnancy[55][56] and is not advised in pregnant women."

I think the problem is the tail end of the second sentence. It is generally true that warfarin is contraindicated (to varying degrees traditionally) throughout pregnancy. However, after week 13 (if that can be determined with reasonable assurance) it is a relative issue (in distinction to the high level contraindication earlier, especially between weeks 4 and 12 traditionally, acknowledging that we now substitute with e.g. LMWH prior to conception when possible), but warfarin may still (optionally) be used (with care) in e.g. high-risk mechanical valve situations etc.

2. On a second minor point, "Only pregnant women with strong risk factors for VTE are suggested to receive targeted (INR of 2.0 to 3.0) preventative measures." would be better phrased as "Only pregnant women with strong risk factors for VTE should receive preventative measures such as warfarin therapy with a target INR of 2.0 to 3.0." The present wording is unduly inexact.

3. Lastly, for several reasons a citation for this corrected sentence would be a reasonable expectation. FeatherPluma (talk) 03:40, 29 July 2012 (UTC)
 * Thanks for the feedback. I think the sourcing for the warfarin sentence is probably the weakest in the entire article, so I will work on this tomorrow. If you have any other ideas you can mention them here or at Peer review/Deep vein thrombosis/archive2, which is currently open. Biosthmors (talk) 15:57, 29 July 2012 (UTC)
 * The current statement is false and potentially harmful. The reference describes the use of warfarin in the postpartum period, not in pregnant women. Warfarin is teratogenic during the first trimester, and can cause dangerous antepartum haemorrhage during the third trimester. Therefore warfarin is contra-indicated during pregnancy. Axl  ¤  [Talk]  17:55, 29 July 2012 (UTC)
 * Glad you caught that. This fixes the error, right? Biosthmors (talk) 21:13, 30 July 2012 (UTC)
 * Recent secondary sources are now cited and I think things are corrected. Biosthmors (talk) 21:57, 30 July 2012 (UTC)
 * Yes, thank you. Axl  ¤  [Talk]  22:46, 30 July 2012 (UTC)

Smoking?
I find it interesting that the article does not list smoking as a causal factor. It seems to be the conventional wisdom that smoking increases the risk of DVT, but the only medical studies I've been able to find online (which are quite old, dating from the late 1970s) concluded that smoking had a PROTECTIVE effect against the formation of DVTs. It would be nice if knowledgeable medical professionals could supplement the article with peer-reviewed evidence about the effects of smoking. I emphasize 'peer-reviewed,' because most websites that list smoking as a causal factor do not cite any evidence in support of the statement. They make logical conclusions about the harmful effects of vasoconstriction and platelet aggregation, but do not validate the conclusions through empirical testing. — Preceding unsigned comment added by 202.130.114.242 (talk) 09:34, 10 August 2012 (UTC)
 * Smoking as a risk factor is cited by some while some cite it as not well established. The mechanism is elusive. I'm not sure whether or not to cite it. "Smoking is a risk factor for VTE, although the effect is much less for arterial thrombosis and the evidence less consistent.16 There are no mechanistic studies on the relationship between VTE and smoking, but it may be safe to postulate an inflammatory state of the endothelim, also involving components of innate immunity." says . The 2008 study they cite is here. Lijfering cites this study and puts it into their table under "Not well established" with a confidence interval of 0.8 to 1.5. van Langevelde says the confidence interval is 1.3 to 1.7 for a risk of DVT in smokers after citing the same 2008 study. Biosthmors (talk) 22:11, 10 August 2012 (UTC)
 * has a nice section devoted to this topic. Biosthmors (talk) 19:13, 5 September 2012 (UTC)

Primary study on aspirin after unprovoked VTE
is the study and might be an appropriate secondary source. Biosthmors (talk) 05:24, 25 August 2012 (UTC)

Recent review article
This might be useful: It says under Risk of recurrence after unprovoked VTE, that men have a higher risk of recurrent VTE than women, and it's gives generally good coverage of the other risk factors. Graham Colm (talk) 14:43, 10 September 2012 (UTC)
 * Thanks for pointing this article out. Biosthmors (talk) 21:27, 10 September 2012 (UTC)
 * Please be careful not to conflate VTE with DVT. Axl  ¤  [Talk]  22:51, 10 September 2012 (UTC)
 * Surely, thanks. Biosthmors (talk) 17:22, 11 September 2012 (UTC)

Removing some sources
I don't understand the value behind this edit because the version before already said that, and now (after removing the sources that appear to have no value) it appears the source that is left understates what is unnecessary, which appears to contradict the article. So I'm going to remove it. Biosthmors (talk) 02:49, 27 September 2012 (UTC)

Comprehensiveness

 * For comprehensiveness, the epidemiology section should include a paragraph on provoked DVT, and provoked DVT should probably be defined in classification. Biosthmors (talk) 19:52, 25 October 2012 (UTC)


 * Duration of anticoagulation in those with cancer could be mentioned, as could more detail on preventative treatments after surgeries. Biosthmors (talk) 19:53, 25 October 2012 (UTC)


 * Guideline for chronic cases. Biosthmors (talk) 19:23, 14 November 2012 (UTC)


 * New drugs, such as rivaroxaban, in the research directions section. Biosthmors (talk) 17:11, 16 November 2012 (UTC)

Consistency
Thrombus or thrombosis? Biosthmors (talk) 04:19, 6 November 2012 (UTC)
 * Imo, both: thrombosis for the condition, thrombus / thrombi for the actual clot/s. —MistyMorn (talk) 08:50, 7 November 2012 (UTC)
 * Hmmmm... OK thanks I'll look at this further. Biosthmors (talk) 19:53, 7 November 2012 (UTC)
 * Etymologically: thrombosis, clot formation; thrombus, the clot formed. At least, that's according to Wikipedia...  ;) —MistyMorn (talk) 20:42, 7 November 2012 (UTC)

High probability or high-probability? Biosthmors (talk) 22:19, 10 November 2012 (UTC)
 * You mean "A Wells score can be divided into two (likely vs. unlikely) or three (low, moderate, or high probability) groups"? If so,looking good as is. More generally, to hyphen or not to hyphen in adjectival phrases that qualify a noun, like "high-throughput PCR", depends on house style. Wikipedia seems to like them, BMJ doesn't , and some, like Malleus, have, on occasion, been known to get hot-under-the-collar (ouch, no!) hot under the collar. —MistyMorn (talk) 22:55, 10 November 2012 (UTC)
 * Thanks I'll remove. Biosthmors (talk) 23:19, 10 November 2012 (UTC)
 * Hmmm.... "at-risk", "bed-rest", "oxygen-deprived"... I need to find a rule to draw the line and make things consistent... Biosthmors (talk) 23:34, 10 November 2012 (UTC)
 * Looks like Malleus might handle that for you. :) —MistyMorn (talk) 00:33, 11 November 2012 (UTC)
 * I'm a hyphen black belt, no worries on that score. As a general rule Biosthmors you only need need hyphens with compound adjectives, to avoid ambiguity. For example, "Wayne Rooney is a well-known footballer", as opposed to "Wayne Rooney is well known". Malleus Fatuorum 03:57, 11 November 2012 (UTC)
 * Excellent (Rooney apart)! Presumably where the convention originally came from. —MistyMorn (talk) 10:32, 11 November 2012 (UTC)
 * Thanks Malleus for your help. I wonder if "at-risk long-haul travelers" should be "at-risk-long-haul travelers". This document helped clarify most issues. Biosthmors (talk) 21:02, 14 November 2012 (UTC)

Clarification query
''In the United States (U.S.) population, about 5 to 8% of people have thrombophilia of some form. Among people who develop VTE, 30 to 50% have thrombophilia. Prevalence estimates are as follows: 0.5 to 9% for antithrombin deficiency, 3 to 9% for protein C deficiency, 1 to 3% for protein S deficiency, 12 to 20% for heterozygous factor V Leiden, 6 to 8% for heterozygous prothrombin G20210A, 0.2 to 4% for the homozygous case, and 2 to 4.5% for individuals doubly heterozygous for factor V Leiden and prothrombin G20210A. ''

Prevalence among whom? Among people who develop VTE in the U.S.? (Sorry, I don't have access to the paper.) —MistyMorn (talk) 00:51, 7 November 2012 (UTC)
 * I'll replace the U.S. centric reference with Varga completely to generalize, thanks. Biosthmors (talk) 02:08, 7 November 2012 (UTC)
 * Great. —MistyMorn (talk) 08:36, 7 November 2012 (UTC)

Upper extremity deep vein thrombosis
UEDVT should perhaps be split off into its own article. Biosthmors (talk) 19:51, 7 November 2012 (UTC)

Wells score
A section of the 2012 NICE guideline, Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing: worth citing here (and, perhaps, elsewhere)? Also, Righini et al, 2006 may be helpful, although as a primary study it doesn't technically meet WP:MEDRS. —MistyMorn (talk) 09:46, 12 November 2012 (UTC)
 * Thanks for the tip. I plan to work that guideline in to avoid systemic bias per JFW's comments here. Biosthmors (talk) 16:34, 12 November 2012 (UTC)
 * Thanks, I'd missed that. Fwiw, I also feel there are more acronyms/abbreviations than necessary. Although they generally seem to be standard ones which could normally be included in a review article, I feel a more conservative approach is preferable on Wikipedia (though I don't see much on the subject in WP:MEDMOS). —MistyMorn (talk) 20:08, 12 November 2012 (UTC)
 * Thanks again. There's another comment like that in the peer review, so I'll plan on moving that way with GCS, IPC, and PTS. Currently, I think VTE is repeated enough/central enough to keep. Biosthmors (talk) 20:20, 12 November 2012 (UTC)
 * FYI, I'm leaning towards keeping VKA and LMWH. Biosthmors (talk) 19:03, 15 November 2012 (UTC)

History
Someone has written a history of DVT. Citeable: 10.1111/jth.12127 JFW &#124; T@lk  21:38, 15 January 2013 (UTC)
 * Great, thanks! Biosthmors (talk) 22:14, 15 January 2013 (UTC)
 * The article has yet to be incorporated into the article's history section but I do plan on doing so. Biosthmors (talk) 18:23, 18 December 2019 (UTC)

Comments
The imaging images might be better presented horizontally in that section with one of these: Template:Multiple_image. Biosthmors (talk) 22:25, 3 March 2013 (UTC)
 * Done. Biosthmors (talk) 17:20, 4 April 2013 (UTC)

Epidemiology of provoked DVT might be a topic to include. Biosthmors (talk) 01:58, 12 March 2013 (UTC)

Inherited risk factors and DVT
All the recent reviews I remember seeing only list genetically determined blood states as inherited risk factors. So I don't think listing May–Thurner syndrome/Cockett syndrome/Iliac vein compression syndrome is best as was done with this edit. This source, on page 15S, says "Knowledge of the underlying cause of iliac vein compression syndrome...", which to me suggests we shouldn't assume it's a purely genetic/inherited trait. Biosthmors (talk) 17:17, 4 April 2013 (UTC)

Post-thrombotic syndrome and thrombophilia
10.1111/jth.12447 - the hypothesis that thrombophilia leads to an increased risk of post-thrombotic syndrome can be rejected. Systematic review & meta-analysis. JFW &#124; T@lk  13:26, 13 November 2013 (UTC)

Treatment review
10.1001/jama.2014.65 JAMA JFW &#124; T@lk  11:06, 20 February 2014 (UTC)

Developments
Mainly about NOACs - Br J Haem 10.1111/bjh.13431 JFW &#124; T@lk  12:03, 23 April 2015 (UTC)

Laterality
http://www.nejm.org/doi/full/10.1056/NEJMcp1407434 mentions laterality in pregnancy at the beginning of the article, which seems worthy of a mention, at least in a footnote. Biosthmors (talk) pls notify me (i.e. &#123;&#123;U&#125;&#125;) while signing a reply, thx 12:18, 16 September 2015 (UTC)

Compression stockings
... are not much good 10.1016/j.amjmed.2015.11.031 JFW &#124; T@lk  11:59, 11 March 2016 (UTC)
 * I believe that the article reflects this knowledge now. Biosthmors (talk) 17:52, 2 January 2020 (UTC)

Lancet seminar
10.1016/S0140-6736(16)30514-1 JFW &#124; T@lk  08:25, 2 September 2016 (UTC)

Merge
Have removed the merge tag. For one venous thrombosis includes a wide variety of conditions (DVT, PE, cerebral venous thrombosis, etc). DVT is one specific type of venous thrombosis. Doc James (talk · contribs · email) 05:55, 31 December 2016 (UTC)

Prevention
Prevention/research directions looks like it could use updating perhaps. Biosthmors (talk) pls notify me (i.e. &#123;&#123;U&#125;&#125;) while signing a reply, thx 13:11, 4 April 2017 (UTC)
 * In general, http://journal.publications.chestnet.org/SS/Antithrombotic_Guideline.aspx could be used to update the article. Biosthmors (talk) pls notify me (i.e. &#123;&#123;U&#125;&#125;) while signing a reply, thx 22:01, 21 June 2017 (UTC) (dead link)

External links modified
Hello fellow Wikipedians,

I have just modified one external link on Deep vein thrombosis. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:
 * Added archive https://web.archive.org/web/20120127090223/http://www.acssurgery.com/acs/chapters/ch0606.htm to http://www.acssurgery.com/acs/chapters/ch0606.htm

When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.

Cheers.— InternetArchiveBot  (Report bug) 23:21, 7 September 2017 (UTC)