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Djup ventrombos

Senast reviderad:


Definition:
Trombosbildning i de stora, djupt liggande venerna i vader, lår, bäcken eller arm-/skulderregionen.
Förekomst:
Den åldersjusterade incidensen är omkring 130/100 000/år för män och 110/100 000/år för kvinnor.
Symtom:
Typiska inflammationstecken som smärta, värme, rodnad, svullnad och nedsatt funktion – men symtomen finns inte alltid. Patienten klagar ofta över ömhet eller smärta när han/hon står eller går. Vanligtvis lindras smärtan av vila med det påverkade benet i högläge.
Kliniska fynd:
Ensidigt ödem i vaden, rodnad och temperaturökning på den påverkade sidan. Venstas/prominenta ytliga vener. Ömhet vid palpation.
Diagnostik:
Wells score och D-dimer är till hjälp för att bedöma sannolikhet för DVT i primärvård. Diagnosen ställs genom bilddiagnostisk undersökning, i första hand ultraljud.
Behandling:
Avlastning innan säker diagnos, tidig mobilisering, kompression och antikoagulationsbehandling. NOAK är förstahandsval som sekundärprofylax.
  1. Robert-Ebadi H, Righini M. Should we diagnose and treat distal deep vein thrombosis? Hematology Am Soc Hematol Educ Program. 2017 Dec 8;2017(1):231-236. doi: 10.1182/asheducation-2017.1.231. PMID: 29222260 PubMed  
  2. Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12(8):464-474. doi:10.1038/nrcardio.2015.83. PMID: 26076949 PubMed  
  3. Apenteng PN, Hobbs FR, Roalfe A, et al. Incidence of venous thromboembolism in care homes: a prospective cohort study. Br J Gen Pract 2017 Feb; 67 (655): e130-e137. pmid:28093420. PubMed  
  4. Goldhaber SZ. Risk factors for venous thromboembolism. J Am Coll Cardiol. 2010;56(1):1-7. doi:10.1016/j.jacc.2010.01.057. PMID: 20620709 PubMed  
  5. Stanley A and Young A. Primary prevention of thromboembolism in medical and surgical oncology patients. BJC 2010; 102; 10-16. PMID: 20386544 PubMed  
  6. Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med. 2010 Nov 6. Epub ahead of print. PMID: 21057984 PubMed  
  7. Watson HG, Baglin TP. Guidelines on travel-related venous thrombosis. Br J Haematol. 2011;152(1):31-34. doi:10.1111/j.1365-2141.2010.08408.x. PMID: 21083651 PubMed  
  8. Kearon C, Ageno W, Cannegieter SC, et al. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost. 2016;14(7):1480-1483. PMID: 27428935 PubMed  
  9. Cohen AT, Katholing A, Rietbrock S, Bamber L, Martinez C. Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A population-based cohort study. Thromb Haemost. 2017;117(1):57-65. doi:10.1160/TH15-08-0686. PMID: 27709226 PubMed  
  10. Trigg DE, Wood MG, Kouides PA, Kadir RA. Hormonal influences on hemostasis in women. Semin Thromb Hemost. 2011;37(1):77-86. doi:10.1055/s-0030-1270074. PMID: 21249605 PubMed  
  11. Canonico M, Plu-Bureau G, Lowe GDO, Scarabin P-Y. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ 2008; 336: 1227-31. PMID: 19217541 PubMed  
  12. Rodina MT, Pendleton R, Wheeler M, Rodgers GM. The treatment of venous thromboembolism in special populations Thrombosis Research 2007; 119: 391-402. PubMed  
  13. Laliberté F, Dea K, Duh MS, et al. Does the route of administration for estrogen hormone therapy impact the risk of venous thromboembolism? Estradiol transdermal system versus oral estrogen-only hormone therapy. Menopause 2011; 18: 1052-9. PubMed  
  14. Bernardi E, Camporese G, Büller HR et al. Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis. JAMA 2008; 300: 1653-9. PubMed  
  15. Kearon C , et al. A randomized trial of diagnostic strategies after normal proximal vein ultrasonography for suspected deep venous thrombosis: D-dimer testing compared with repeated ultrasonography. Ann Intern Med 2005; 142: 490-6. PMID: 15809460 PubMed  
  16. Goodacre S, Sutton AJ, Sampson FC. Meta-analysis: The value of clinical assessment in the diagnosis of deep vein thrombosis. Ann Intern Med 2005; 143: 129-39. PubMed  
  17. Garcia-Bolado A, Del Cura JL. CT venography vs ultrasound in the diagnosis of thromboembolic disease in patients with clinical suspicion of pulmonary embolism. Emerg Radiol. 2007;14:403–409. PMID: 17653779 PubMed  
  18. Walker RF, Zakai NA, MacLehose RF, et al. Association of Testosterone Therapy With Risk of Venous Thromboembolism Among Men With and Without Hypogonadism. JAMA Intern Med 2019. pmid:31710339 PubMed  
  19. Khan F, Tritschler T, Kahn SR, Rodger MA. Venous thromboembolism. Lancet. 2021;398(10294):64-77. doi:10.1016/S0140-6736(20)32658-1. PMID: 33984268 PubMed  
  20. Righini M, Perrier A, De Moerloose P et al. D-dimer for venous thromboembolism diagnosis: 20 years later. J Tromb Haemost 2008; 6: 1059-1071. PubMed  
  21. Wells PS, Anderson D, Rodger M et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Eng J med 2003; 349: 1227-35. PMID: 14507948 PubMed  
  22. Bounemeaux H, Perrier A and Righini M. Diagnosis of venous thromboembolism: un update. Vasc Med 2010; 15: 399-406. PubMed  
  23. van der Velde EF, Toll DB, Ten Cate-Hoek AJ et al. Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients. Ann fam Med 2011; 9: 31-6. PubMed  
  24. Geersing GJ, Zuithoff NP, Kearon C, et al. Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data meta-analysis. BMJ. 2014 Mar 10;348:g1340. doi: 10.1136/bmj.g1340. [url]http://dx.doi.org/10.1136/bmj.g1340[/url] PMID: 24615063 PubMed  
  25. Silveira PC, Ip IK, Goldhaber SZ, et al. Performance of Wells score for deep vein thrombosis in the inpatient setting. JAMA Intern Med 2015; 175: 1112-7. DOI: 10.1001/jamainternmed.2015.1687 PMID: 25985219 PubMed  
  26. Segal JB, Streiff MB, Hofmann LV, Thornton K, Bass EB. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med 2007; 146: 211-22. PubMed  
  27. Huo MH and Spyropoulis AC. The eighth American college of chest phycisians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies. J Thromb Thrombolysis 2010 (e-pub ahead of print). PMID: 20686823 PubMed  
  28. Gaitini D. Multimodality imaging of the peripheral venous system. Int J Biomed Imaging ;2007:54616. PMID: 18521181 PubMed  
  29. Carrier M, Le Gal G, Wells PS, Fergusson D, Ramsay T, Rodger MA. Systematic review: The Trousseau Syndrome revisited: Should we screen extensively for cancer in patients with venous thromboembolism? Ann Intern Med 2008;149: 323-33. PMID: 18765702 PubMed  
  30. Rieu V, Shanier S, Philippe P, Ruivard M. Systematic screening for occult cancer in elderly patients with venous thromboembolism: a prospective study. Intern Med J 2011 Feb 10 (e-pub ahead of print). PMID: 21309993 PubMed  
  31. Blodpropp – förebyggande, diagnostik och behandling av venös tromboembolism. SBU-rapport 2002. www.sbu.se  
  32. Carrier M, Lazo-Langner A, Shivakumar S, et al. Screening for occult cancer in unprovoked venous thromboembolism. N Engl J Med. 2015. PMID: 26095467. PubMed  
  33. Hempel E-L. Trombos kan betyda oupptäckt cancer. Evidens. Senast ändrat 2018-09-10 (Hämtad 2020-11-24). janusinfo.se  
  34. Region Örebro län. Djup ventrombos. 2020-10-07 (Hämtad 2020-11-24). www.regionorebrolan.se  
  35. Castellucci LA, Cameron C, Le Gal G, et al. Clinical and safety outcomes associated with treatment of acute venous thromboembolism. A systematic review and meta-analysis. JAMA 2014; 312: 1122-35. doi:10.1001/jama.2014.10538 PMID: 25226478 PubMed  
  36. Bhutia S, Wong PF. Once versus twice daily low molecular weight heparin for the initial treatment of venous thromboembolism. Cochrane Database Syst Rev. 2013 Jul 16;7. PMID: 23857562. PubMed  
  37. Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev. 2021;1(1):CD002783. Published 2021 Jan 19. doi:10.1002/14651858.CD002783.pub5. PMID: 33464575 PubMed  
  38. Benjamin D Fox, Susan R Kahn, David Langleben et al. Efficacy and safety of novel oral anticoagulants for treatment of acute venous thromboembolism: direct and adjusted indirect meta-analysis of randomised controlled trials. BMJ. 2012; 345: e7498 PubMed  
  39. Robertson L, Kesteven P, McCaslin JE. Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of deep vein thrombosis. Cochrane Database Syst Rev. 2015 Jun 30;6:CD010956. Cochrane (DOI)  
  40. Shirley M, Dhillon S. Edoxaban: A Review in Deep Vein Thrombosis and Pulmonary Embolism. Drugs. 2015 Nov;75(17):2025-34. PMID:26546477. PubMed  
  41. Själander S, Själander A. NOAK vid venös tromboembolism samt hantering av blödningar. Lakartidningen.se 2018-12-04. lakartidningen.se  
  42. Dosering av lågmolekylärt heparin, fondaparinux och perorala antikoagulantia vid behandling av venös tromboembolism hos patienter med övervikt respektive undervikt, Janusinfo, region Stockholm, 2021-06-03 janusinfo.se  
  43. Goldenberg NA, Kittelson JM, Abshire TC, et al. Effect of Anticoagulant Therapy for 6 Weeks vs 3 Months on Recurrence and Bleeding Events in Patients Younger Than 21 Years of Age With Provoked Venous Thromboembolism The Kids-DOTT Randomized Clinical Trial. JAMA 2022; 327: 129-37. pmid:35015038 PubMed  
  44. Antikoagulantiabehandling av patienter med cancersjukdom och venös tromboemboli. Janusinfo, Region Stockholm. Hämtad 2019-06-25 www.janusinfo.se  
  45. Burgstaller JM, Steurer J, Held U, et al. Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis. Vasa. 2016;45(2):141-7. PMID: 27058800. PubMed  
  46. Kahn, S et al. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 2014; 383: 880-888. PubMed  
  47. Berntsen CF, Kristiansen A, Akl EA, et al. Compression Stockings for Preventing the Postthrombotic Syndrome in Patients with Deep Vein Thrombosis. Am J Med. 2016 Apr;129(4):447.e1-447.e20. PMID: 26747198. PubMed  
  48. Clarke MJ, Broderick C, Hopewell S, Juszczak E, Eisinga A. Compression stockings for preventing deep vein thrombosis in airline passengers. Cochrane Database Syst Rev. 2021;4(4):CD004002. Published 2021 Apr 20. doi:10.1002/14651858.CD004002.pub4. PMID: 33878207 PubMed  
  49. Geerts WH, Bergqvist D, Pineo GF et al. Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: S381-S453. PMID: 18574271 PubMed  
  50. Sachdeva A, Dalton M, Amaragiri SV, et al. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev. 2014 Dec 17;12:CD001484. doi: 10.1002/14651858.CD001484.pub3. PMID: 25517473 PubMed  
  51. Shalhoub J, Lawton R, Hudson J, et al. Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): randomised controlled trial. BMJ. 2020;369:m1309. Published 2020 May 13. PMID: 32404430 PubMed  
  52. ICM-VTE Hip & Knee Delegates. Recommendations from the ICM-VTE: Hip & Knee. J Bone Joint Surg Am. 2022;104(Suppl 1):180-231. doi:10.2106/JBJS.21.01529. PMID: 35315610 PubMed  
  53. Kahn SR. The post-thrombotic syndrome. Hematology Am Soc Hematol Educ Program. 2016;2016(1):413-418. PubMed  
  54. Li R, Yuan M, Cheng J, et al. Risk of post-thrombotic syndrome after deep vein thrombosis treated with rivaroxaban versus vitamin-K antagonists: A systematic review and meta-analysis published online ahead of print, 2020 Sep 17. Thromb Res. 2020;196:340-348. PMID: 32977134 PubMed  
  55. Douketis J, Tosetto A, Marucci M, et al. Risk of recurrence after venous thromboembolism in men and women: patient level meta-analysis. BMJ 2011; 342: d813. PMID: 21349898 PubMed  
  56. Reitter SE, Waldhoer T, Mayerhofer M et al. Long-term survival of patients with a history of venous thromboembolism. Ann Hematol Feb 2011 (online first). PMID: 21287349 PubMed  
  57. Khan F, Rahman A, Carrier M, et al. Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. BMJ 2019; 366: l4363. pmid:31340984 PubMed  
  58. Pollack CV, Reilly PA, van Ryn J, et al. Idarucizumab for dabigatran reversal - full cohort analysis. N Engl J Med 2017. doi:10.1056/NEJMoa1707278. PMID: 28693366 PubMed  
  59. Rutherford OW, König MSS, Risnes K, Raouf N, Atar D, Ghanima W. Antidotbehandling ved bruk av direktevirkende antikoagulasjonsmidler Antidote treatment during use of direct anticoagulants. Tidsskr Nor Laegeforen. 2018;138(3):10.4045/tidsskr.17.0190. Published 2018 Feb 5. PMID: 29411596 PubMed  
  60. Niessner A, Tamargo J, Morais J et al. Reversal strategies for non-vitamin K antagonist oral anticoagulants: a critical appraisal of available evidence and recommendations for clinical management-a joint position paper of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Working Group on Thrombosis. Eur Heart J 2017; 38: 1710 - 6. PMID: 26705385 PubMed  
  61. Nationellt kliniskt kunskapsstöd. Förmaksflimmer (hämtad 2022-06-28) nationelltklinisktkunskapsstod.se  
  62. Husseinzadeh H, Carrier M. Occult cancer detection in patients with hemostatic disorder and venous thromboembolism. Thromb Res 2017. pmid:28587726 PubMed  
  • Peter J Svensson, professor och överläkare, Koagulationscentrum, Skånes universitetssjukhus
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet