Povzetek
Objective: To determine the effect of the introduction of Doppler ultrasonography to the management of venous thromboembolism in a health care facility in Nigeria. Method: A descriptive study of cases of venous thromboembolism (VTE) over a five year period (March 2007-February 2012) was compared with a five year review done two decades ago before the introduction of Doppler ultrasonography.
Results: This review showed an increase of VTE cases from 60 to 178 with a median age of 53yrs, median age of female patients was 5yrs younger than male patients with Male/female ratio of 1:1.2. There was an even distribution of patients seen over the five year period with a mean prevalence of 35.6 patients per year. Patients with distal deep vein thrombosis (DVT) were in the majority (76%) compared with proximal DVT and PE which were 21% Vs 3%. About 4% of the patients had a recurrence of the VTE with male patients having twice the likelihood of a re-thrombosis. Common co-morbid states observed are cerebrovascular disease (14.5%), cancers (12.2%), retroviral disease (6.7%) and diabetes (6.2%). Prostatic cancer was more common than other cancers while patients with retroviral disease are more likely to have an extensive DVT.
Conclusion: The introduction of Doppler ultrasonography increased the awareness and diagnosis of VTE, we suggest that patients with associated disease conditions are placed on prophylactic anticoagulation, it is also necessary to determine the prevalence of inherited causes of VTE in the population.
Keywords: Embolism, iliofemoral, prophylaxis, therapeutic, anticoagulation
Résumé
Objectif: Déterminer l’effet de l’introduction de l’échographie-Doppler pour la gestion de la maladie thromboembolique veineuse dans les centres de santé au Nigeria.
Méthode: Une étude descriptive des cas de thromboembolie veineuse (TEV) sur une période de cinq ans (Mars 2007-Février 2012) a été comparée à un examen quinquennal fait, il ya deux décennies avant l’introduction de l’échographie-doppler.
Résultats: Cette étude a montré une augmentation des cas d’ETEV de 60 à 178 avec un âge moyen de 53 ans. L’âge moyen des patientes était de 5 ans plus jeune que chez les hommes ayant un rapport mâle / femelle de 1:1,2.La répartition des patients examinés au cours de la période de cinq ans était homogène avec une fréquence moyenne de 35,6 patients par an. Les patients atteints de thrombose veineuse distale profonde (TVP) étaient en majorité 76% par rapport à une TVP proximale et le PE était de 21% contre 3%. Environ 4% des patients ont eu une récidive de la thromboembolie veineuse chez les patients masculins ayant deux fois la probabilité d’une nouvelle thrombose. Les états fréquents de Co-morbides qui ont été observés sont des maladies cérébrauxvasculaires (14,5%), les cancers (12,2%), la maladie rétrovirale (6,7%) et le diabète (6,2%). Le Cancer de la prostate est plus fréquent que les autres cancers alors que les patients atteints de la maladie rétrovirale sont plus susceptibles d’avoir un vaste TVP.
Conclusion: L’introduction de l’échographie Doppler a augmenté la prise de conscience et le diagnostic de MTEV. Au finish, nous suggérons que les patients atteints de maladies associées aux conditions médicales soient placés sur l’anti-coagulation prophylactique. Il est également nécessaire de déterminer la fréquence des causes héréditaires de la TEV parmi nos populations.
Correspondence: Dr. T.R. Kotila, Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: tkotila@comui.edu.ng
Literatura
Okunade MA, Kotila TR, Shokunbi WA and Aken’Ova YA. Venous thromboembolism in Ibadan: A five year experience (1986-1990). Nig Qt J Hosp Med. 1998; 8(2): 80-82.
Griffin JH, Evatt B, Zimmerman TS et al. Deficiency of protein C in congenital thrombotic disease. J Clin Invest. 1981; 65(5):1370-1373.
Schwarz HP, Fischer M, Hopmener P, et al. Plasma protein S deficiency in familial thrombotic disease. Blood 1984; 64:1297-1300.
Bertina RM, Koeleman BP, Koster et al. Mutation in blood coagulation factor V associated with resistance to activated Protein C. Nature 1994; 369(6475):64-67.
Crowther MA and Warkentin TE. Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood 2008;111(10):4871-4879.
Yang DH, Li J, He JA, et al. Deep venous thrombosis of lower extremities: effects of different treatment on the incidence of pulmonary embolism. Zhonghua Wai Ke Za Zhi 2009; 47(23): 1787-1789.
Sun P and Dong DN. Clinical analysis of 20 pregnant women with venous thromboembolic disease. Zhonghua Fu Chan Ke Za Zhi 2011; 46(12):911-916.
Tagalaskis V, Kondal D and Ji Y, Boivin JF. Men had a higher risk of recurrent venous thromboembolism than women: A large population study. Gend Med 2012 9(1):33-43.
Januel JM, Cheng G, Ruffleux C, et al. Symptomatic in- hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review. JAMA 2012;307(3):294-303.
Malek J, Rogers R, Kufera J, et al. Venous thromboembolic disease in the HIV infected patient. Am J Emerg Med 2011;29(3):278-282.
Kiser KL and Badowski ME. Risk factors for venous thromboembolism in patients with immunodeficiency virus infection. Pharmacotherapy 2010;30(12):1292-1302.
Ogeng’o JA, Obimbo MM, Olabu BO, et al. Pulmonary thromboembolism in an East African Tertiary referral hospital. J Thromb Thrombolysis 2011;32(3):386-391.
Bennett D, Abate J and Abrahamson PE. Characteristics of patients with venous thromboembolism and atrial fibrillation in Venezuela. BMC Public Health 2011;11:415-420
Saxena R, Batra VV and Singh ND. Prothrombic factors in nephritic syndrome. Indian J Pathol microbial 2000;43(3):319-323.
Htike N, Superdock K, Thiruveedi S, et al. Evaluating protein and nephritic syndrome in patients with venous thromboembolism. Am J Med Sci 2012;343(2):124-126.