Značajke i ishodi bolesnika s dubokom venskom trombozom dijagnosticiranih u Hitnoj službi Kliničke bolnice Dubrava tijekom 2019. godine

master's thesis

• Title (english): Characteristics and outcomes of patients with deep vein thrombosis diagnosed in Emergency Department of Clinical Hospital Dubrava during 2019
• Author: Ivan Radilj
• Mentor: Zdravko Mitrović (mentor)
• Committee member: Vlatko Pejša (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Zdravko Mitrović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Duboka venska tromboza (DVT) učestalo je kliničko stanje u Hitnom bolničkom prijemu. Nakon uvođenja novih oralnih antikoagulansa (NOAK), sve veći broj bolesnika s DVT-om ne zahtijeva hospitalizaciju. U ovoj retrospektivnoj opservacijskoj studiji, analizirali smo medicinsku dokumentaciju pacijenata dijagnosticiranih s DVT-om tijekom 2019. godine u Hitnom prijemu Kliničke bolnice Dubrava. Identificirano je 295 pacijenata, koji čine 1.2% svih bolesnika pregledanih u Hitnom prijemu. Bilo je 121 muškaraca (41%) i 174 žena (59%), s medijanom dobi od 65 (raspon 20-94) godina. Većina pacijenata (71%) imala je proksimalnu trombozu, 24% imalo je izoliranu distalnu trombozu noge, a 5% se prezentiralo jugularnom ili trombozom vene ruke. Također, 19% bolesnika imalo je istovremeno plućnu emboliju. Hospitalizirano je 70% bolesnika, a 25% je liječeno ambulantno. DVT je bio idiopatski u 42%, a ostalih 58% pacijenata imalo je sekundarnu DVT uslijed: maligne bolesti (41%); traume, operacije i imobilizacije (33%), nepokretnosti (11%) i ostalih uzroka (13%). Najpropisivaniji lijek bio je rivaroksaban (52% pacijenata). Varfarinom je liječeno 20% bolesnika, a 11% dabigatranom ili apiksabanom. Kontrolni ultrazvuk izveden je kod 58% pacijenata, s potpunim oporavkom kod 63%. NOAK-i uzrokuju manje epizoda krvarenja nego varfarin (3.2% prema 13.6%; p<0.05). Naši rezultati pokazuju da pacijenti s DVT-om mogu biti sigurno izvanbolnički liječeni NOAK-ima te u budućnosti očekujemo još višu stopu ambulantnog liječenja NOAK-ima.

Abstract (english)

Deep vein thrombosis (DVT) is a relatively common condition in Emergency Department (ED). After the introduction of novel anticoagulants (NOAC), many patients with DVT do not require hospitalization. In this retrospective observational study, we analyzed medical records of patients diagnosed with DVT during 2019 in ED of University Hospital Dubrava. We identified 295 patients with DVT that comprised 1.2% of all patients examined in ED. There were 121 (41%) men and 174 (59%) women, with a median age of 65 years (range 20-94 years). Most patients (71%) had proximal DVT, 24% had isolated distal leg thrombosis, and 5% had jugular or arm thrombosis. Additionally, 19% of the patients had pulmonary embolism simultaneously. Hospitalization was required in 70% of the patients and 25% were treated in outpatient setting. DVT was idiopathic in 42% of the patients and the rest (58%) had secondary DVT due to malignancy (41%); trauma, operation and imobilization (33%), immobility (11%) and other causes (13%). Rivaroxaban was most commonly prescribed drug (52% of all patients). Warfarin was used at 20% of patients and 11% were treated with dabigatran or apixaban. Control Doppler ultrasonography was performed in 58% of the patients, with complete resolution in 63%. NOACs caused less bleeding events than warfarin (3.2% vs. 13.6%, p<0.05). Our results demonstrate that patients with DVT can be safely treated with NOAC in outpatient setting. In future, we expect even higher rate of outpatient management with NOAC.

• Keywords: duboka venska tromboza; hitna služba; NOAK; varfarin; krvarenje
• Keywords (english): deep vein thrombosis; emergency department; NOAC; warfarin; bleeding
• Language: croatian
• URN:NBN: urn:nbn:hr:105:520688
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-05-04 08:54:41