Summary

Impact of emergency department management of isolated superficial vein thrombosis of the lower limbs: a secondary analysis of data from the ALTAMIRA study

Fahd Beddar Chaib1,2, Sònia Jiménez Hernández3, José María Pedrajas Navas4, Ramón Lecumberri5,6, Leticia Guirado Torrecillas7, Héctor Alonso Valle8, Susana Diego Roza9, Vanesa Sendín Martín4, Mª Angélica Rivera Núñez10, Jorge Pedraza García11, Daniel Sánchez Díaz-Canel12, Pedro Ruiz Artacho13-15, en representación del Grupo de Enfermedad Tromboembólica Venosa de la Sociedad Española de Medicina de Urgencias y Emergencias (ETV-SEMES)

Affiliation of the authors

1Emergency Department, Complejo Asistencial de Soria, Soria, Spain. 2University of Valladolid, Faculty of Health Sciences, Valladolid, Spain. 3Emergency Department, Hospital Clínic. IDIBAPS, Barcelona, Spain. 4Internal Medicine Department, Hospital Clínico San Carlos, Madrid. Madrid, Spain. 5Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain. 6CIBER-CV, Madrid, Spain. 7Emergency Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 8Emergency Department, Hospital Marqués de Valdecilla, Santander, Spain. 9Emergency Department, Hospital Valle de Nalón, Oviedo, Spain. 10Emergency Department, Hospital la Paz, Madrid, Spain. 11Emergency Department, Hospital Valle de los Pedroches, Córdoba, Spain. 12Emergency Department, Hospital Universitario La Ribera, Valencia, Spain. 13Department of Internal Medicine, Clínica Universidad de Navarra, Madrid, Spain. 14CIBER of Respiratory Diseases, CIBERES, Madrid, Spain. 15Interdisciplinary Teragnosis and Radiosomics (INTRA) Research Group, University of Navarra, Spain.

DOI

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Beddar Chaib F, Jiménez Hernández S, Pedrajas Navas JM, Lecumberri R, Guirado Torrecillas L, Alonso Valle H, et al. Impact of emergency department management of isolated superficial vein thrombosis of the lower limbs: a secondary analysis of data from the ALTAMIRA study. Emergencias. 2023;35:109-16

Summary

Objectives.

To describe the management of superficial vein thrombosis (SVT) of the lower limbs in patients treated in Spanish hospital emergency departments (EDs). To evaluate the impact of ED management of venous thromboembolic complications on outcomes and to determine the characteristics of patients who develop complications.

Methods.

The retrospective multicenter ALTAMIRA study (Spanish acronym for risk factors, complications, and assessment of Spanish ED management of SVT) used recorded data for consecutive patients with a diagnosis of isolated SVT treated in 18 EDs. We gathered data on symptomatic venous thromboembolic disease (deep vein thrombosis, pulmonary embolism, or the extension or recurrence of SVT), clinically significant bleeding, and 180-day mortality. Cox regression analysis was used to explore variables associated with complications.

Results.

A total of 703 patients were included. Anticoagulation was prescribed for 84.1% of the patients for a median of 30 days (interquartile range, 15-42 days); 81.3% were treated with low molecular weight heparin. A prophylactic dose was prescribed for 48% and an intermediate therapeutic dose for 52%. Sixty-four patients (9.2%) developed symptomatic thromboembolic disease within 180 days, 12 (1.7%) experienced clinically significant bleeding, and 4 (0.6%) died. Complications developed later in patients receiving anticoagulant therapy than in those not taking an anticoagulant (66 vs 11 days , P=.009), and 76.6% of those developing complications were not on anticoagulant when symptoms appeared. A history of thromboembolic disease was associated with developing complications (adjusted hazard ratio, 2.20; 95% confidence interval, 1.34-3.62).

Conclusions.

ED treatment of SVT varies and is often suboptimal. The incidence of thromboembolic complications after SVT is high. Starting anticoagulation in the ED delays the development of complications. Patients with a history of thromboembolic disease are more at risk of complications.

 

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