Characteristics of isolated superficial vein thrombosis and diagnostic-therapeutic management in Spanish hospital emergency departments: the ALTAMIRA study
Beddar Chaib F, Jiménez Hernández S, Pedrajas Navas JM, Carriel Mancilla J, Castro Arias L, Merlo Loranca M, Peiró Gómez A, Álvarez Márquez A, Lozano Polo L, Sánchez Garrido-Lestache A, Lecumberri R, Ruiz Artacho P
Affiliation of the authors
Servicio de Urgencias, Complejo Asistencial de Soria, Spain. Universidad de Valladolid, Facultad de Ciencias de la Salud, Valladolid, Spain. Área de Urgencias, Hospital Clinic, IDIBAPS, Barcelona, Spain. Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain. Servicio de Medicina Interna, Gastro Obeso Center, Guayaquil, Ecuador. Facultad de Ciencias Médicas, Universidad Católica De Santiago de Guayaquil, Ecuador. Servicio de Urgencias, Hospital Doce de Octubre, Madrid, Spain. Servicio de Urgencias, Hospital Universitario de Getafe, Madrid, Spain. Servicio de Urgencias, Hospital Arnau de Vilanova-Lliria, Valencia, Spain. Servicio de Urgencias, Hospital Universitario Nuestra Señora de Valme, Sevilla, Spain. Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Servicio de Urgencias, Hospital General de Albacete, Albacete, Spain. Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. CIBER-CV, Pamplona, Navarra, Spain. Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain. Interdisciplinar Teragnosis and Radiosomics (INTRA) Research Group, Universidad de Navarra, Spain.
Beddar Chaib F, Jiménez Hernández S, Pedrajas Navas JM, Carriel Mancilla J, Castro Arias L, Merlo Loranca M, et al. Characteristics of isolated superficial vein thrombosis and diagnostic-therapeutic management in Spanish hospital emergency departments: the ALTAMIRA study. Emergencias. 2021;33:433-40
Summary
Objectives.
To describe the characteristics of patients with isolated lower-limb superficial vein thrombosis (SVT) treated in hospital emergency departments and to evaluate adherence to clinical practice guidelines on diagnosis (vein ultrasound imaging) and therapeutic management (start of anticoagulant therapy).
Methods.
Retrospective cohort study in 18 Spanish emergency departments. We included all patients with a final emergency department diagnosis of lower-limb SVT aged 18 years or older between January 2016 and May 2017. Backward stepwise multiple logistic regression analysis was used to evaluate adherence to clinical practice guidelines on ordering vein ultrasound imaging and starting anticoagulant therapy.
Results.
A total of 1166 patients were included. The mean patient age was 59.6 years, and 67.9% were women. About a quarter of the patients (24.4%) had a history of venous thromboembolic disease. Complications developed in 8.9% within 180 days: 4.6% experienced a recurrence and 3.6% progressed to SVT and 1.8% to deep vein thrombosis; pulmonary thromboembolism occurred in 0.9%. Hemorrhagic complications developed in 17 patients (1.5%). Sixteen patients (1.4%) died. Vein ultrasound imagine was ordered for 703 patients (60.3%). Anticoagulant agents were prescribed for 898 (77%) for a median period of 22 days. Variables associated with a decision to order anticoagulants were a history of venous thromboembolic disease (odds ratio [OR], 1.60; 95% CI, 1.12–2.30), varicose veins (OR, 1.40; 95% CI, 1.12–2.30); limb pain (OR, 1.44; 95% CI, 1.08–1.91); painful cord (OR, 1.30; 95% CI, 0.97–1.73); and availability of vein ultrasound images (OR, 1.60; 95% CI, 1.94–3.45).
Conclusions.
Adherence to clinical practice guidelines for the diagnosis and treatment of isolated lower-limb SVT is low in Spanish emergency departments. Ultrasound imaging is not ordered for 1 out of every 2 to 3 patients, and anticoagulant treatment is not started in 1 out of 4 patients. There is great room for improvement.
