The survey of deep vein thrombosis and venous thromboembolism prevention: Japanese Vein Study XIII (pp. 133-148)
Authors: (Hirono Satokawa, Takashi Yamaki, Hirohide Iwata, Masahiro Sakata, Norihide Sugano, Toshiya Nishibe, Makoto Mo and Norikazu Yamada)
Abstract: Several years have passed since the guidelines of venous thromboembolism (VTE) treatment and VTE prevention were published. The treatment of deep vein thrombosis (DVT) is changing greatly. This study was performed to investigate the risk factors, diagnostic methods, distribution, and treatment of DVT and to investigate VTE prevention in Japan. A questionnaire survey was mailed to the members of the Japanese Society of Phlebology. The contents of the survey dealt with the treatment of new DVT cases in the year 2009 and the prevention of VTE. The results were examined and compared to the result of our former survey. 1162 patients were reported from 70 institutions. The sex ratio (men to women) was 1 to 2 and the age ranged from 15 to 102 (average 69). Surgery was the most important risk factor for DVT (38.2%). As for the onset time, the acute onset (within 13 days) occurred in 486 patients (41.8%) and the subacute (14-29 days) in 70 (6.0%). Subsequent pulmonary thromboembolism was diagnosed in 174 patients (15.0%). For diagnosis, an ultrasound method was mainly used (87.7%), whereas phlebography was used for only 33 patients (2.8%). DVT was found in left lower limb in 531 patients (48.6%), in right lower limb in 360 patients (33.0%) and in bilateral limbs in 201 patients (18.4%). DVT locations were proximal type (52.2%) and distal type (47.8%), which included 119 patients with bilateral distal type. In the distal type, soleal vein thrombosis was most frequent (84.3%) and then peroneal vein thrombosis (19.9%). Patients were mainly treated medicinally (80.8%). Medication included unfractionated heparin (57.0%) and Urokinase (11.1%). Catheter-directed thrombectomy was performed in 22 cases (2.4%) and surgical thrombectomy was done only in 14 (1.6%). Vena cava filter was inserted for 155 patients (17.2%): retrievable type (66.5%), permanent type (21.3%) and temporary type (9.7%). Prophylactic methods were used at 60 institutions (85.7%). The precautions were elastic stockings (91.4%), early ambulation (84.3%), pneumatic compression (81.4%) and anticoagulant drugs (52.9%).
The number of DVT patients has increased and the frequency of the distal type especially increased. Anticoagulant therapy is most common medical treatment. The total frequency of vena cava filter was similar to our previous survey; however, the use ratio of retrievable type increased
comparatively. Prophylactic methods for VTE were used in most institutions, however, the rate of anticoagulation administration was not high and is considered to be insufficient in Japan.
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