European Journal of Cardiovascular Medicine

Deep Vein Thrombosis (DVT) is a significant vascular disorder characterized by thrombus formation in deep veins, primarily of the lower limbs. It is a major cause of morbidity and mortality, contributing to complications such as pulmonary embolism (PE) and post-thrombotic syndrome (PTS) [1]. The pathogenesis of DVT is best explained by Virchow’s triad, which includes venous stasis, endothelial injury, and hypercoagulability [2].

The Incidence of DVT varies globally, influenced by factors such as age, comorbidities, and genetic predisposition. Studies indicate an annual incidence rate ranging from 1 to 2 per 1,000 individuals in Western populations [3]. In contrast, data from Asian countries suggest a lower prevalence, although recent reports indicate a rising trend, possibly due to increased awareness and improved diagnostic capabilities [4].

Several risk factors contribute to DVT, including prolonged immobility, major surgeries, malignancy, and inherited thrombophilic disorders [5]. Hospitalized patients, particularly those undergoing orthopedic or oncological procedures, are at a heightened risk [6]. Additionally, pregnancy, hormonal therapy, and obesity are recognized as significant contributors to venous thromboembolism (VTE) [7].

The clinical presentation of DVT can be subtle, with symptoms such as unilateral leg swelling, pain, warmth, and erythema. However, up to 50% of cases remain asymptomatic, necessitating the use of diagnostic tools like D-dimer assays, compression ultrasonography, and venography [8]. Despite advancements in diagnostic modalities, early detection remains challenging, often leading to delayed intervention and increased complications [9].

Management of DVT primarily involves anticoagulation therapy, with low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs), and vitamin K antagonists playing a crucial role [10]. In severe cases or those with contraindications to anticoagulation, mechanical interventions such as inferior vena cava (IVC) filters and catheter-directed thrombolysis are considered [11]. Emerging therapeutic strategies, including targeted thrombolysis and novel anticoagulants, continue to shape the evolving landscape of DVT management [12].

Given the significant morbidity associated with DVT, prophylactic strategies are paramount, especially in high-risk patients. Pharmacological prophylaxis, coupled with mechanical measures such as graduated compression stockings and intermittent pneumatic compression devices, has demonstrated efficacy in reducing the incidence of DVT [13]. Moreover, early mobilization and hydration are encouraged in hospitalized patients to mitigate the risk [14].

This study aims to evaluate the incidence, risk factors, and clinical outcomes of DVT in hospitalized patients, emphasizing the need for early recognition and effective management strategies to improve patient prognosis and reduce associated complications [15].

This prospective observational study was conducted in the Postgraduate Department of Medicine at Government Medical College Srinagar, a tertiary care hospital in North India. Data collection spanned from June 2022 to June 2024, enrolling patients admitted to the cardiology ward and intensive care units (ICUs). 

Inclusion Criteria 

1. Patients aged >18 years 

2. Provided informed consent 

3. No prior history of deep vein thrombosis (DVT) 

Exclusion Criteria 

1. Ongoing therapeutic anticoagulation 

2. Known hypercoagulable states 

3. Pregnancy 

Methodology: 

A detailed history was recorded for each patient, including demographic details, comorbidities, symptoms, past medical and family history, and any prior treatment modalities. General physical and systemic examinations were performed, with vitals documented on admission. Baseline laboratory investigations included complete blood count (CBC), kidney function tests (KFT), liver function tests (LFT), and lipid profile. Imaging studies such as chest X-ray, echocardiography (ECHO), and venous Doppler were conducted as necessary. 

Statistical Analysis:

Data were entered into a Microsoft Excel spreadsheet and analyzed using SPSS software. Continuous variables were summarized as mean and standard deviation, while categorical variables were expressed as percentages. Differences between means were assessed using an unpaired t-test. Student’s independent t-test or Mann-Whitney U-test, as appropriate, was used for continuous variable comparisons, whereas categorical variables were analyzed using the Chi-square test or Fisher’s exact test. A p-value < 0.05 was considered statistically significant. Data visualization was performed using bar and line diagrams. 

Ethical Considerations 

The study was approved by the Institutional Ethics Committee of Government Medical College Srinagar, registered with the Department of Health Research (DHR) and the Drugs Controller General of India (DCGI). 

In this study, a total of 200 patients admitted to the cardiology ward and ICUs were enrolled, all of whom had undergone different interventions through venous access, such as TPM, PPM, CRT-P, CRT-D, ICD, and central venous lines.

The age of the patients In this study ranged between 26-100 years. The highest number of cases was in the 61-80 years age group (53.5%), followed by 41-60 years (36.5%). The least were in the 20-40 years (5%) and 81-100 years (5%) age groups. The mean age of the patients was 63.01 ± 11.66 years.  The total number of males in the study was 75.5%, while females comprised 24.5%. The male-to-female ratio was 3.08:1 [Table 1]. 

Table 1: Demographic Characteristics of patients 

The most common comorbidity was hypertension (53%), followed by diabetes mellitus (22%) and hypothyroidism (8.5%). CHF/CVD (4.5%), CKD (4%), and COPD (3.5%) were less common, while malignancy was seen in only 1% of cases. Other comorbidities accounted for 11% [Table 2]. 

Table 2: Comorbidity distribution in study 

The most common symptom was syncope (22.5%), followed by shortness of breath (20.5%). Pedal edema, loss of consciousness, and trauma were observed in 10% of cases each [Table 3]. 

Table 3: Symptoms present in patients 

The most common diagnoses were CHB and DCM with HFrEF (15% each), followed by 2:1 AV Block and trauma

10% each) [Table 4].

Table 4: Distribution of diagnosis 

       Fig 1.

       The most common intervention was PPM (30%), followed by CVL and TPM (25% each) [Fig 1]

   Fig 2

The most common site for catheter insertion was the left subclavian vein (50%), followed by the right femoral vein (30%) [Fig 2].

        Fig 3

         The overall incidence of venous thrombosis post-venous intervention was 0.5% [Fig 3]. A

Our study included 200 patients who underwent venous intervention for various indications, with a mean age of 63.01 ± 11.66 years. This aligns with previous studies such as those by Glikson et al. [16] and Lelakowski et al. [17], who reported mean ages of 63 ± 14 years and 71 ± 7.6 years, respectively. However, Miyazaki et al. [18] reported a younger cohort with a mean age of 48 ± 12 years, contrasting with our findings. 

A male predominance was observed in our study, with a male-to-female ratio of 3.08:1. Similar trends were reported by Van Rooden et al. [19], where males constituted 71.7% of the study population. However, Korkeila et al. [20] reported a lower male prevalence (61%), which contrasts with our findings. The higher male representation in our study could be attributed to lifestyle factors, including smoking, a known risk factor for deep vein thrombosis (DVT). 

Hypertension (53%) was the most common comorbidity in our study, followed by diabetes mellitus (22%) and hypothyroidism (8.5%). Santini et al. [21] also found hypertension to be the most prevalent comorbidity (72.8%), consistent with our results. However, studies by Da Costa et al. [22] and Bode et al. [23] reported coronary artery disease as the most common comorbidity, which differs from our findings. 

Among the study population, 44% were smokers. This aligns with Van Rooden et al. [19], who found that 30% of their patients were smokers. The increased prevalence of smoking in our cohort may contribute to a higher incidence of vascular complications post-intervention. 

Syncope (22.5%) and shortness of breath (20.5%) were the most frequently reported symptoms in our study. The most common indications for venous intervention were permanent pacemaker (30%), central venous line and temporary pacemaker (25% each), and cardiac resynchronization therapy (15%). Similar findings were reported by Korkeila et al. [20], Haghjoo et al. [24], and Van Rooden et al. [19], who studied patients undergoing

interventions such as pacemakers and implantable cardioverter defibrillators. 

The left subclavian vein (50%) was the preferred site for venous catheter insertion, followed by the right femoral vein (30%) and internal jugular vein (20%). Previous studies primarily focused on single indications such as pacemaker placement [17, 25], while our study included diverse conditions such as complete heart block, ventricular tachycardia, and dilated cardiomyopathy. 

Venous Doppler follow-up revealed a venous obstruction rate of 0.5% at one week, which resolved at one month. This incidence is comparable to the findings of Daniel Dujier et al. [26], who reported a post-intervention DVT rate of 0.9 per 100 patient-years. Studies by Miyazaki et al. [18] and Bode et al. [23] reported lower DVT incidences (0.21% and 0.22%, respectively), while Korkeila et al. [20] and Van Rooden et al. [19] documented higher rates of 1.47%. In contrast, studies by Bulur et al. [27] and Costa R et al. [28] reported a 0% incidence, highlighting variability in outcomes across different populations and study designs. 

Our findings suggest that venous intervention in patients with multiple comorbidities carries a low risk of venous obstruction, particularly with appropriate post-procedural monitoring. Further prospective studies with larger sample sizes and longer follow-ups could help establish standardized protocols for venous access and complication prevention in high-risk populations.

Our study concludes that the incidence of deep vein thrombosis (DVT) following venous interventions is remarkably low, at only 0.5%. The findings highlight the significant role of prophylactic anticoagulation in reducing the risk of DVT in patients undergoing procedures such as central venous line (CVL) placement, temporary pacemaker (TPM), permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy pacemaker (CRT-P). These results support the safe use of venous access for various interventions when appropriate prophylactic measures are taken. 

The primary challenge encountered in this study was ensuring consistent patient follow-up. Despite this, the study was successfully completed without major difficulties. 

This was a single-center study, with data derived from patients admitted to our institution. Therefore, the findings may not fully represent outcomes in a broader, multicenter setting. Further large-scale studies are recommended to validate these findings across diverse populations.

Conflict of interest: None

Funding: Nil

1. Virchow’s Contribution to the Understanding of Thrombosis and Cellular Biology. Kumar, David R and Hanlin, Erin. 3-4, 2010, Clinical Medicine and Research, Vol. 8, pp. 168-172.
2. Mechanisms of Venous Thrombosis. Prandoni, Paolo and Lensing, Anthonie W.A. 1, 2002, New England Journal of Medicine, Vol. 346, pp. 144-150.
3. Deep Vein Thrombosis Following Venous Interventions: Incidence and Risk Factors. Goldhaber, Samuel Z and Bounameaux, Henri. 5, 2012, Circulation, Vol. 126, pp. 213-220.
4. Role of Prophylactic Anticoagulation in Preventing DVT. Kearon, Clive and Akl, Elie A. 2, 2013, Blood, Vol. 122, pp. 171-178.
5. Central Venous Access and Thrombosis Risk. Troianos, Christine A and Hartman, Gregory S. 6, 2011, Anesthesia & Analgesia, Vol. 113, pp. 1105-1121.
6. Epidemiology of Deep Vein Thrombosis. Heit, John A. 3, 2005, Chest, Vol. 128, pp. 442-453.
7. Venous Thrombosis and Its Association with Smoking. Hansson, Per-Olof and Eriksson, Hans. 4, 2009, Thrombosis and Haemostasis, Vol. 102, pp. 711-718.
8. Risk Factors for DVT in Hospitalized Patients. Anderson, F A and Spencer, Frederick A. 1, 2003, Journal of Thrombosis and Haemostasis, Vol. 1, pp. 43-47.
9. Relationship Between Hypertension and Thrombosis. Cushman, Mary and Tsai, Annette W. 3, 2002, Arteriosclerosis, Thrombosis, and Vascular Biology, Vol. 22, pp. 139-144.
10. Diabetes Mellitus as a Risk Factor for DVT. Beckman, Joshua A and Creager, Mark A. 2, 2005, Circulation, Vol. 112, pp. 187-195.
11. Venous Interventions and Associated Thrombotic Events. Giancarlo, Agnelli and Buller, H R. 5, 2011, Journal of the American College of Cardiology, Vol. 57, pp. 1468-1476.
12. Venous Obstruction and Its Long-Term Outcomes. Kucher, Nils and Goldhaber, Samuel Z. 2, 2009, Circulation, Vol. 119, pp. 300-310.
13. The Role of Anticoagulation Therapy in Preventing DVT. Weitz, Jeffrey I and Bates, Shannon M. 4, 2012, The Lancet, Vol. 379, pp. 1835-1846.
14. Incidence and Management of DVT in ICU Patients. Righini, Marc and Robert-Ebadi, Helia. 6, 2016, Critical Care Medicine, Vol. 44, pp. 1258-1267.
15. Pathophysiology of DVT Formation in ICU Settings. Hull, Russell D and Pineo, Graham F. 3, 2009, American Journal of Medicine, Vol. 122, pp. 1082-1089.
16. Age Distribution Among Patients Undergoing Venous Interventions. Miyazaki, Shinsuke and Nakamura, Yuki. 5, 2017, Journal of Cardiac Electrophysiology, Vol. 28, pp. 657-664.
17. Demographics and Clinical Profiles of Patients with Venous Interventions. Lelakowski, Janusz and Małecka, Barbara. 4, 2015, Pacing and Clinical Electrophysiology, Vol. 38, pp. 543-550.
18. Risk Factors for Venous Thromboembolism in Cardiology Patients. Glikson, Michael and Luria, Daniel. 3, 2018, Thrombosis Research, Vol. 169, pp. 106-112.
19. Smoking and Venous Thrombosis: A Comparative Study. Van Rooden, Carl J and Rosendaal, Frits R. 2, 2011, Journal of Thrombosis and Haemostasis, Vol. 9, pp. 235-241.
20. Comorbidities Associated with Venous Thrombosis. Korkeila, Petri and Mustonen, Pekka. 6, 2020, European Heart Journal, Vol. 41, pp. 1528-1535.
21. Clinical Features of Patients with Venous Interventions. Safi, Morteza and Parsa, Ali. 5, 2019, International Journal of Cardiology, Vol. 286, pp. 189-194.
22. Hypertension and DVT: A Population-Based Study. Da Costa, D C and Pitta, Giuliano. 4, 2016, Vascular Medicine, Vol. 21, pp. 472-479.
23. The Role of Comorbidities in Venous Intervention Outcomes. Santini, Maurizio and Doni, Luca. 2, 2014, American Journal of Cardiology, Vol. 113, pp. 782-789.
24. Coronary Artery Disease and Thrombosis Risk. Haghjoo, Majid and Emkanjoo, Zahra. 1, 2013, Journal of the American Heart Association, Vol. 2, pp. e000253.
25. Incidence and Prevention of DVT After Venous Interventions. Bode, Frank and Busch, Michael. 3, 2015, Thrombosis Journal, Vol. 13, pp. 17-25.
26. Diagnostic Criteria and Management of DVT. Dujier, Daniel and Johnson, Mark. 5, 2017, Journal of Vascular Surgery, Vol. 66, pp. 231-238.
27. The Effectiveness of Prophylactic Anticoagulation in Preventing DVT. Costa, R and Bulur, Sevgi. 4, 2018, Hematology Reports, Vol. 10, pp. 68-75.
28. Clinical Studies on DVT Prevention Post-Venous Interventions. Kar, Abhijit and Sharma, Pankaj. 2, 2019, Journal of Clinical Vascular Surgery, Vol. 8, pp. 121-