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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, JimĂ©nez HernĂĄndez S, Pedrajas Navas JM, Lecumberri R, Guirado Torrecillas L, Alonso Valle H, Diego Roza S, SendĂ­n MartĂ­n V, Rivera NĂșñez MA, Pedraza GarcĂ­a J, SĂĄnchez DĂ­az-Canel D, Ruiz Artacho P

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