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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 287-290

Prevalence of deep vein thrombosis in congestive cardiac failure patients


Department of General Medicine, SKIMS Medical College, Srinagar, Jammu and Kashmir, India

Date of Submission21-May-2021
Date of Acceptance28-Apr-2022
Date of Web Publication17-Sep-2022

Correspondence Address:
Dr. Abdul Ahad Wani
Department of General Medicine, SKIMS Medical College, Bemina, Srinagar - 190 015, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_132_21

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  Abstract 


BACKGROUND: Congestive cardiac failure (CCF) and deep vein thrombosis (DVT) may coexist in a patient. The prevalence of DVT has been reported up to 34.1% in CCF patients, and its presence may increase the morbidity and mortality of CCF patients. The presence of DVT may increase the morbidity and mortality of CCF patients. With this background in mind, we conducted a study to know the prevalence of DVT in CCF patients from our part of the world.
MATERIALS AND METHODS: An analytical cross-sectional study was carried out over a period of 1 year from March 2015 to February 2016 on 50 patients admitted with CCF to our hospital. After obtaining information on underlying comorbid illness, duration of CCF symptoms, and preliminary investigations, the patients were subjected to venous Doppler ultrasound.
RESULTS: A total of 50 patients admitted with the diagnosis of CCF were enrolled in this study. The mean age of patients was 63.28 ± 9.5 years. The mean body mass index of the patients was 24.48 ± 2.8 kg/m2. Five out of 50 patients were found to have deep vein thrombosis in our study. The duration of symptoms of more than 10 days before seeking medical consultation was statistically significant in patients of CCF with DVT.
CONCLUSION: In our study, 10% of patients with CCF had DVT on venous Doppler ultrasound. A longer duration of CCF symptoms before seeking medical consultation was significantly associated with DVT in our patients.

Keywords: Congestive cardiac failure, deep-vein thrombosis, venous Doppler ultrasound


How to cite this article:
Naik M, Bhat T, Gowhar W, Wani AA. Prevalence of deep vein thrombosis in congestive cardiac failure patients. Indian J Health Sci Biomed Res 2022;15:287-90

How to cite this URL:
Naik M, Bhat T, Gowhar W, Wani AA. Prevalence of deep vein thrombosis in congestive cardiac failure patients. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Sep 25];15:287-90. Available from: https://www.ijournalhs.org/text.asp?2022/15/3/287/356266




  Introduction Top


Congestive cardiac failure (CCF) is one among the common causes of admissions in the elderly population and is considered an independent and a major risk factor for the development of deep vein thrombosis in hospitalized patients. However, CCF also increases the risk of deep vein thrombosis (DVT) in outpatients as well.[1] There may occur a delay in seeking medical advice in patients with minimal symptoms of CCF, especially in the elderly population. Deep vein thrombosis may develop during hospitalization or patient may be harboring it at the time of admission in patients with CCF.

The average mortality of CCF is 10%–20% after 1 year and primarily depends on the development of deep vein thrombosis and its consequence, i.e., pulmonary thromboembolism (PTE). They are responsible for 1/10 hospital-related deaths[2] and are the most common cause of preventable hospital deaths.[3] The clinical outcome of PTE is death in 25% of cases, and most patients die within half an hour of the acute event.[3] In its chronic form, PTE can lead to chronic thromboembolic pulmonary arterial hypertension (HTN) in 0.1%–4.0% of patients, which is either due to incompletely resolved or an organized embolus that gets incorporated in the pulmonary artery wall.[4] Deep vein thrombosis leads to venous thromboembolism (VTE) as an acute complication and postthrombotic syndrome as its chronic complication. Symptomatic PTE is associated with 18 times higher risk of early mortality than that in patients with deep vein thrombosis alone.[5] Life expectancy is significantly lower, and quality of life is impaired after an acute episode of PTE as compared to an episode of DVT alone.

CCF management becomes difficult if CCF is associated with VTE because symptoms of CCF may mimic that of VTE and the latter may remain undiagnosed and increase morbidity and mortality of CCF.[6] With this background in mind, we conducted a study to know the prevalence of DVT in CCF in our patient population.


  Materials and Methods Top


This analytical cross-sectional survey was conducted in the Department of General Medicine, SKIMS Medical College and Hospital, Srinagar, over a period 1 year from March 2015 to February 2016, after obtaining approval from the Institutional Ethical Clearance Committee. Written informed consent was taken from all patients. Fifty adult patients (15 males and 35 females) admitted to our hospital with a diagnosis of CCF were included in the study. After taking a detailed history of symptom onset, seeking medical advice, and underlying comorbid conditions, the patients were subjected to preliminary investigations such as complete blood count, kidney function test, liver function test, blood sugar, electrocardiography, X-ray chest, and bilateral lower limb venous Doppler. The study was approved by the institutional ethics committee SKIMS medical college & hospital, Srinagar, Kashmir (IEC/SKIMS MC Protocol No. 34/IEC/03/2015, dated 30/03/2015).

Venous Doppler ultrasound was performed with a high-resolution 7.5 MHz linear array transducer. The deep veins were evaluated for compressibility at 1-cm intervals from the common femoral vein to the point where the popliteal vein joins the calf veins. Patients were diagnosed with deep vein thrombosis if the vein was noncompressible on venous Doppler ultrasound. In patients with a past history of deep vein thrombosis, new-onset deep-vein thrombosis was diagnosed if there was a new noncompressible site or if the diameter of the clot had increased by at least 4 mm from a previous measurement. If the change in clot diameter was 1 mm or less, recurrence was ruled out. If the clot diameter had increased by 1.1–3.9 mm, the ultrasound examination was repeated 1 week later.

Inclusion criteria

Any patient admitted with diagnosis of congestive cardiac failure.

Exclusion criteria

Patients of CCF who were already on anticoagulants were excluded from the study. Furthermore, patients with a history of malignancy, recent fracture, pregnancy, patients on antidepressants, history of thrombophilia in the past or in the family, recent surgery, and prolonged immobilization for any other reason were excluded from this study.

Statistical analysis

Statistical analysis was performed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. (Armonk, NY: IBM Corp.). The normality of test was done by Shapiro–Wilk test. Mean with standard deviation was used for normally distributed data, whereas median with interquartile range was used for variables that were not normally distributed. P < 0.05 was considered statistically significant.


  Results Top


A total of 50 patients (15 males and 35 females) admitted with the diagnosis of CCF were enrolled in this study. The mean age of patients was 63.28 ± 9.5 years. The mean body mass index (BMI) of the patients was 24.48 ± 2.8 kg/m2. HTN was the most common comorbidity (92%) in admitted patients with CCF, followed by chronic obstructive pulmonary disease (COPD) (54%), diabetes (32%), hypothyroidism (20%), dilated cardiomyopathy (DCM) (18%), obstructive sleep apnea (OSA) (10%), coronary artery disease (CAD) (6%), rheumatic heart disease (RHD) (4%), and chronic kidney disease (4%). Forty-eight percent of patients were smokers, and 18% had a history of CCF in the previous year. Thirty patients (60%) had symptoms of <10 days and 20 patients (40%) had symptoms of >10 days of CCF before seeking medical consultation.

Five out of 50 patients were found to have deep vein thrombosis in our study. There was no statistical difference in age, sex, and BMI among patients of CCF with DVT as compared to patients of CCF without DVT. Although no statistically significant difference was noted, the mean age of patients of CCF without DVT was lesser as compared to patients of CCF with DVT (63.04 ± 9.94 years vs. 65.4 ± 5.45 years; P = 0.60). The duration of symptoms of more than 10 days was statistically significant in patients of CCF with DVT as compared to CCF without DVT (odd ratio: 0.356, 95% confidence interval; (0.24–0.52), P = 0.006). All other important baseline characteristics of patients of CCF with and without DVT are mentioned in [Table 1] and [Table 2].
Table 1: Age and body mass index in patients of congestive cardiac failure with deep vein thrombosis and congestive cardiac failure without deep vein thrombosis

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Table 2: Comorbidities in patients of congestive cardiac failure with deep vein thrombosis and congestive cardiac failure without deep vein thrombosis

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There was no significant association between smoking status, prior history of CCF, RHD, CAD, diabetes mellitus, HTN, COPD, DCM, heart transplantation, OSA, CKD, anemia, and left ventricular dysfunction among patients of CCF with DVT and without DVT.


  Discussion Top


Deep-vein thrombosis was found in 10% of CCF inpatients in our study which is in accordance with the studies conducted by Howell et al., Alikhan et al., and Ota et al.[1],[7],[8] However, a study from Japan reported the prevalence of DVT in 34.1% of patients of CCF in 2014.[9] A higher prevalence of DVT of up to 40% has been reported in CCF patients in Western studies.[10] Interestingly, the prevalence of DVT in Western patients admitted for other medical conditions other than CCF has been reported in the range of 10%–26%.[11],[12],[13]

Alikhan et al. reported a high DVT incidence rate in cases of severe congestive heart failure up to 21.7% in New York heart association Class IV and overall in 14.6% in CCF patients, an observation which is in accordance with ours.[7] Ota et al. in 2009 from Japan reported DVT in 11.2% of patients admitted with CCF which.[8] The frequency of DVT in CCF has been reported as low as 1.03% by Beemath et al. in CCF patients,[14] although on venography, the incidence of VTE was reported as 12.2% in CCF patients by Howell et al.[1]

We did not find any significant difference in age, weight, body mass index, duration of CCF before admission, or smoking status in patients of CCF with or without DVT. We did not find any significant difference in the left ventricular ejection fraction (LVEF) between the CCF patients with or without DVT as was reported by (LVEF) was reported in a study.[15] There was no association between potential risk factors and the development of DVT in our study which can be explained by the fact that the small sample size of the study population may be the reason behind the dissent of risk factors with the occurrence of DVT. Five out of the 10 patients in our study had proximal DVT, and five had distal DVT. We treated both proximal as well as distal patients of DVT with anticoagulants.

Although CCF is considered a risk factor for DVT and a prevalence of up to 40% has been reported, and prophylaxis is recommended in patients of CCF, it has not been included as of in the Wells score for DVT. The prevention of DVT in hospitalized nonsurgical patients continues to be a difficult challenge, and anticoagulation therapy is recognized as the strongest prophylaxis for DVT.


  Conclusion Top


Deep vein thrombosis was reported in 10% of patients admitted with CCF in our study. DVT should be suspected in patients of CCF who seek medical consultation, especially more than 10 days of symptom onset. Awareness about early medical consultation after symptom onset in patients susceptible to CCF should be strongly encouraged.

Acknowledgment

Our special thanks to Mr. Amit assistant Electronic data processing SKIMS MCH Srinagar, for providing technical support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Howell MD, Geraci JM, Knowlton AA. Congestive heart failure and outpatient risk of venous thromboembolism: A retrospective, case-control study. J Clin Epidemiol 2001;54:810-6.  Back to cited text no. 1
    
2.
Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:338S-400S.  Back to cited text no. 2
    
3.
Clagett GP, Anderson FA Jr., Heit J, Levine MN, Wheeler HB. Prevention of venous thromboembolism. Chest 1995;108:312S-34S.  Back to cited text no. 3
    
4.
Piovella F, D'Armini AM, Barone M, Tapson VF. Chronic thromboembolic pulmonary hypertension. Semin Thromb Hemost 2006;32:848-55.  Back to cited text no. 4
    
5.
Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Predictors of survival after deep vein thrombosis and pulmonary embolism: A population-based, cohort study. Arch Intern Med 1999;159:445-53.  Back to cited text no. 5
    
6.
Piazza G, Seddighzadeh A, Goldhaber SZ. Heart failure in patients with deep vein thrombosis. Am J Cardiol 2008;101:1056-9.  Back to cited text no. 6
    
7.
Alikhan R, Cohen AT, Combe S, Samama MM, Desjardins L, Eldor A, et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness. Arch Intern Med 2004;164:963-8.  Back to cited text no. 7
    
8.
Ota S, Yamada N, Tsuji A, Ishikura K, Nakamura M, Ito M. Incidence and clinical predictors of deep vein thrombosis in patients hospitalized with heart failure in Japan. Circ J 2009;73:1513-7.  Back to cited text no. 8
    
9.
Matsuo H, Matsumura M, Nakajima Y, Ogawa T, Tazaki J, Doi T, et al. Frequency of deep vein thrombosis among hospitalized non-surgical Japanese patients with congestive heart failure. J Cardiol 2014;64:430-4.  Back to cited text no. 9
    
10.
Nicolaides AN, Breddin HK, Fareed J, Goldhaber S, Haas S, Hull R, et al. Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence. Int Angiol 2001;20:1-37.  Back to cited text no. 10
    
11.
Samama MM, Cohen AT, Darmon JY, Desjardins L, Eldor A, Janbon C, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med 1999;341:793-800.  Back to cited text no. 11
    
12.
Mismetti P, Laporte-Simitsidis S, Tardy B, Cucherat M, Buchmüller A, Juillard-Delsart D, et al. Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: A meta-analysis of randomised clinical trials. Thromb Haemost 2000;83:14-9.  Back to cited text no. 12
    
13.
Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr., et al. Prevention of venous thromboembolism. Chest 2001;119 Suppl 1:132S-75S.  Back to cited text no. 13
    
14.
Beemath A, Stein PD, Skaf E, Al Sibae MR, Alesh I. Risk of venous thromboembolism in patients hospitalized with heart failure. Am J Cardiol 2006;98:793-5.  Back to cited text no. 14
    
15.
Freudenberger RS, Hellkamp AS, Halperin JL, Poole J, Anderson J, Johnson G, et al. Risk of thromboembolism in heart failure: An analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation 2007;115:2637-41.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2]



 

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