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• W1580946475 abstract "Deep venous thrombosis (DVT) and pulmonary embolism (PE) are common and serious complications occurring in hospitalized patients [1, 2]. The frequency of DVT is well documented in surgical, gynecologic and intensive care unit patients [3-5], and prophylaxis has been shown to significantly reduced the risk of venous thromboembolism. Many medical conditions such as malignancy, neurological diseases with paresis, cardiac failure and acute myocardial infarction are associated with increased risk of thromboembolism, and prophylaxis had also been recommended [6]. There was little data about the incidence of DVT among Chinese patients admitted to a medical ward. In the past, it was widely believed that the incidence of DVT was much lower among the Chinese population than Caucasians, and prophylaxis was generally considered not necessary. In Hong Kong, postoperative DVT was reported in only 0.13–2.6% of the cases [7, 8]. The incidence of DVT in the general Hong Kong population was estimated as 17 per 100 000 [7, 9]. This was lower than the reported incidence of 48–124 per 100 000 reported in the Western population [10, 11]. A DVT incidence of 3 per 10 000 was reported in Malaysia [12]. We reported here that nearly one-third of the DVT cases occurred in patients in medical wards or in patients recently discharged from medical units. The Prince of Wales Hospital is a regional hospital in Hong Kong serving a population of 800 000. From January 2002 to December 2003, 1103 adult patients underwent Doppler ultrasonography of the lower limbs for symptomatic or clinically suspected DVT. A team of experienced radiologists performed the Doppler study. Absent or diminished Doppler flow, lack of respiratory variation, and failure to augment flow with maneuvers (calf compression) were used to establish the diagnosis of DVT. Of 367 patients who had DVT confirmed by ultrasound, 10 had PE. The medical records of these 367 patients were carefully reviewed to determine: (a) the presence of risk factors; (b) how many of them developed DVT during hospitalization in a medical ward; (c) how many of them was readmitted with DVT following a recent discharge from a general medical ward; and (d) whether these patients had received any DVT prophylaxis during the current or previous medical admission. Among the 367 patients with confirmed DVT, 162 developed DVT during hospitalization. Of these, 56 occurred in general medical wards, and the rest in surgical (n = 87), obstetric (n = 9) and intensive care units (n = 10). Among the 56 medical patients, 35 had proximal DVT and nearly three-quarters of them had malignancy (27%), infections (23%), congestive heart failure (13%) and stroke (9%). DVT developed in these 56 patients after at least 3 days of hospital stay (median 10 days, range 3–84 days) (Table 1). Two hundred and five patients were admitted because of DVT. One hundred patients had a recent admission to a general medical ward and 74 had proximal DVT. Of these 100 patients, 42 patients developed DVT within 10 days of discharge and another 34 patients within 1 month. The median age of the 42 patients who developed DVT within 10 days of discharge is 66 years (range 25–90 years). Median in-hospital stay for the previous admission is 14 days (range 2–166 days). Ninety-three per cent of the admissions were 3 or more days. The diagnoses for the previous medical admissions were malignancy (50%), infection diseases including sepsis (21%), congestive heart failure (10%), and cerebral vascular diseases (5%). Other diagnoses included diabetes mellitus, hypertension, chronic obstructive lung disease and intravenous drug addicts. None of these 42 patients received antithrombotic prophylaxis during the previous hospitalization and 37 of them had proximal DVT upon readmission. Forty-nine patients admitted with DVT had no previous medical or surgical admission to hospital. Risk factors in this group included oral contraceptives, pregnancy, and long-haul flights., In our study, the number of DVT cases diagnosed during admission to (n = 56) or within 10 days of discharge from a general medical ward (n = 42) constituted 30% of the cases of confirmed DVT. Seventy per cent (72/98) of them were proximal DVT. It could be argued that for the 42 patients who developed DVT within 10 days of discharge, the previous hospital stay probably contributed significantly to DVT development. During the 2-year study period, there was a total of 36 051 medical admissions. The duration of hospital day was at least 3 days for 25 442 medical admissions. The overall incidence rate of proximal DVT among hospitalized medical patients is at least two per 1000 (72/36051) or three per 1000 (72/25442) among patients with prolonged hospital stay. This is likely to be an under-estimate because Doppler ultrasonography was ordered only for patients with symptomatic or clinically suspected DVT and we did not perform routine Doppler screening. In one previous local study, serial duplex ultrasound detected asymptomatic calf DVT in 20 out of 48 patients undergoing colorectal surgery. However, none of them, including patients with proximal extension, had symptoms [13]. Another study had also reported that only 6–10% of patients with Doppler ultrasound or venography-proven DVT were symptomatic [14]. We therefore suspected that the overall risk of symptomatic and asymptomatic DVT among hospitalized Chinese patients was probably several times higher than that presented in this study and similar to that in Caucasian populations. Most published studies showed a 1–4% incidence of proximal DVT among medical patients with routine venography screening [6]. In summary, our retrospective analysis suggested that the incidence of proximal DVT in Chinese patients admitted to medical wards is substantial. Further prospective studies may help to confirm our findings." @default.
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• W1580946475 date "2004-09-01" @default.
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• W1580946475 title "Estimated risk of deep venous thrombosis among Chinese patients admitted to general medical wards" @default.
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• W1580946475 doi "https://doi.org/10.1111/j.1538-7836.2004.00880.x" @default.
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