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

Beddar Chaib F, Jiménez Hernández S, Pedrajas Navas JM, Lecumberri R, Guirado Torrecillas L, Alonso Valle H, Diego Roza S, Sendín Martín V, Rivera Núñez MA, Pedraza García J, Sánchez Díaz-Canel D, Ruiz Artacho P

Servicio de Urgencias, Complejo Asistencial de Soria, Soria, Spain. Universidad de Valladolid, Facultad de Ciencias de la Salud, Valladolid, Spain. Área de Urgencias, Hospital Clínic. IDIBAPS, Barcelona, Spain. Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid. Spain. Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Spain. 6CIBER-CV, Madrid, Spain. Servicio de Urgencias, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. Servicio de Urgencias, Hospital Marqués de Valdecilla, Santander, Spain. Servicio de Urgencias, Hospital Valle de Nalón, Oviedo, Spain. Servicio de Urgencias, Hospital la Paz, Madrid, Spain. Servicio de Urgencias, Hospital Valle de los Pedroches, Córdoba, Spain. Servicio de Urgencias, Hospital Universitario La Ribera, Valencia, 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..

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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