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Semin Thromb Hemost 2011; 37(3): 298-304
DOI: 10.1055/s-0031-1273093
© Thieme Medical Publishers

Dexter versus Sinister Deep Vein Thrombosis: Which Is the More Sinister? Findings from the NRITLD DVT Registry

Behnood Bikdeli1 , 8 , Babak Sharif-Kashani1 , 2 , 3 , Ehsan Chitsaz1 , Bavand Bikdeli6 , Mandana Chitsazan1 , Saeid Kermani-Randjbar1 , Neda Behzadnia1 , Shahram Yazdani7 , Leila Saliminejad1 , Mohammad-Reza Masjedi4 , 5
  • 1Cardiovascular Department, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran
  • 2Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran
  • 3Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran
  • 4Pulmonary Division, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran
  • 5Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran
  • 6Lyell McEwin Hospital, SA, Australia
  • 7Education Development Center, Shahid Beheshti University MC, Tehran, Iran
  • 8Cardiovascular Research Center, Shahid Beheshti University MC, Tehran, Iran
Further Information

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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 6 May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins.  Angiology. 1957;  8 (5) 419-427
    CrossrefPubMedGoogle Scholar
  • 7 Virchow R. Ueber die Erweiterung kleinerer Gefäfse.  Arch Pathol Anat Physiol Klin Med. 1851;  3 427-462
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Piccioli A, Falanga A, Baccaglini U, Marchetti M, Prandoni P. Cancer and venous thromboembolism.  Semin Thromb Hemost. 2006;  32 (7) 694-699
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 32 Chan W S, Spencer F A, Ginsbergm J S. Anatomic distribution of deep vein thrombosis in pregnancy.  CMAJ. 2010;  182 (7) 657-660
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Behnood BikdeliM.D. 

Cardiovascular Department, National Research Institute of Tuberculosis and Lung Disease

Darabad, Tehran, Iran

Email: bbikdeli@sbmu.ac.ir; behnood61@yahoo.com

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