Email this article Venous thrombosis in patients after intracardial catheter interventions: incidence, risk factors, special aspects of the diagnosis
- Authors: Loginova A.I.1,2, Kropacheva E.S.1,2, Titaeva E.V.1,2, Maykov E.B.1,2, Balakhonova T.V.1,2, Golitsyn S.P.1,2
-
Affiliations:
- National Medical Research Cardiology Center
- Issue: Vol 47, No 4 (2019)
- Pages: 326-333
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/1102
- DOI: https://doi.org/10.18786/2072-0505-2019-47-044
- ID: 1102
Cite item
Full Text
Abstract
Rationale: Thrombosis of the puncture site in the femoral veins is one of the potentially dangerous complications of intracardial catheter interventions associated with thromboembolic risk related to its proximal location. According to the literature, the incidence of symptomatic venous thrombosis (VT) is 1–3%. No special studies on the assessment of risk factors for this complication, its diagnosis and treatment have been conducted.
Aim: To study the incidence, risk factors and special aspects of VT diagnosis in patients undergoing intracardial electrophysiological studies (EFI) and/or catheter ablation.
Materials and methods: This prospective study included 408 patients (194 men and 214 women, with median age of 51±10.1 years), who were admitted to the hospital with various cardiac rhythm disorders for intracardial EFIs and/or catheter ablations from 2016 to 2018. Before the interventions, in addition to common laboratory and instrumental work-up, all the patients underwent ultrasound duplex scanning (USDS) of the iliac-femoral segment; in 269 patients the level of D-dimer was measured. Latest at 24 hours after the intervention, all patients underwent a control ultrasound scan of the femoral vein puncture site. In case of VT occurrence anticoagulant therapy was started in all patients and they were followed up till complete VT resolution and at least for 3 months (the study endpoint). The VT incidence and its risk factors including the prognostic value of D-dimer levels were evaluated.
Results: The VT incidence after catheter interventions was 11.7% (n=48). There was a significant correlation between VT occurrence and such risk factors as diabetes mellitus (p=0.001) and obesity (p<0.001). No association between elevated baseline D-dimer values (>500 ng/mL) and subsequent VT development was found (p>0.05). The quartile analysis revealed an association between baseline D-dimer levels exceeding 434 ng/mL (which corresponds to the range of 75 to 100%) and the presence of the following risk factors: age over 65 years (p<0.001), female gender (p=0.001), arterial hypertension (p=0.003), chronic coronary heart disease (p=0.044).
Conclusion: In this study, all VTs (11.7%) detected after catheter transvenous interventions by USDS were asymptomatic. VTs were most frequent in patients with diabetes mellitus and obesity. D-dimer had no predictive value in the development of VT; however, its increased baseline values were more common in women, patients over 65 years, and in patients with arterial hypertension and chronic coronary heart disease.
Keywords
About the authors
A. I. Loginova
National Medical Research Cardiology Center;
Author for correspondence.
Email: dr.loginova.a@gmail.com
Anastasia I. Loginova – MD, Cardiologist, Postgraduate Student, Department of Clinical Electrophysiology and X-Ray Methods of Treatment of Cardiac Arrhythmias
15A 3-ya Cherepkovskaya ul., Moscow, 121552
РоссияE. S. Kropacheva
National Medical Research Cardiology Center;
Email: fake@neicon.ru
Ekaterina S. Kropacheva – MD, PhD, Senior Research Fellow, Department of Clinical Problems of Atherothrombosis.
15A 3-ya Cherepkovskaya ul., Moscow, 121552
РоссияE. V. Titaeva
National Medical Research Cardiology Center;
Email: fake@neicon.ru
Elena V. Titaeva – PhD (in Biol.), Senior Research Fellow, Department of Clinical Problems of Atherothrombosis.
15A 3-ya Cherepkovskaya ul., Moscow, 121552
РоссияE. B. Maykov
National Medical Research Cardiology Center;
Email: fake@neicon.ru
Evgeny B. Maykov – MD, PhD, Senior Research Fellow, Laboratory of Interventional Methods for Diagnostics and Treatment of Cardiac Rhythm and Conduction Disorders and Syncopal Conditions, Department of Clinical Electrophysiology and X-Ray Methods of Treatment of Cardiac Arrhythmias.
15A 3-ya Cherepkovskaya ul., Moscow, 121552
РоссияT. V. Balakhonova
National Medical Research Cardiology Center;
Email: fake@neicon.ru
ORCID iD: 0000-0002-7273-6979
Tatyana V. Balakhonova – MD, PhD, Professor, Chief Research Fellow, Department of Diagnostic Radiology.
15A 3-ya Cherepkovskaya ul., Moscow, 121552
РоссияS. P. Golitsyn
National Medical Research Cardiology Center;
Email: fake@neicon.ru
Sergey P. Golitsyn – MD, PhD, Professor, Head of Department of Clinical Electrophysiology and X-Ray Methods of Treatment of Cardiac Arrhythmias.
15A 3-ya Cherepkovskaya ul., Moscow, 121552
РоссияReferences
- Чазов ЕИ, ред. Руководство по кардиологии в 4 т. М.: Практика; 2014.
- Burstein B, Barbosa RS, Kalfon E, Joza J, Bernier M, Essebag V. Venous Thrombosis After Electrophysiology Procedures: A Systematic Review. Chest;152(3):574–86. doi: 10.1016/j.chest.2017.05.040.
- Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation/Heart Rhythm. 2017;14(10):e275–444. doi: 10.1016/j.hrthm.2017.05.012.
- Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NA 3rd, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM; Evidence Review Committee Chair. Circulation. ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology /American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. 2016;133(14):e506–74. doi: 10.1161/CIR.0000000000000311.
- Бокерия ЛА, Затевахин ИИ, Кириенко АИ, Андрияшкин АВ, Андрияшкин ВВ, Арутюнов ГП, Баринов ВЕ, Бицадзе ВО, Бодыхов МК, Бритов АН, Бутенко АВ, Вавилова ТВ, Воробьева НА, Восканян ЮЭ, Гавриленко АВ, Галстян ГМ, Гельфанд БР, Гиляров МЮ, Голубев ГШ, Замятин МН и др. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО). Флебология. 2015;9(4–2):1–52.
- Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing GJ, Kyrle PA; Subcommittees on Control of Anticoagulation, and Predictive and Diagnostic Variables in Thrombotic Disease. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost. 2016;14(7):1480–3. doi: 10.1111/jth.13336.
- Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349(13):1227–35. doi: 10.1056/NEJMoa023153.
- Horowitz LN, Kay HR, Kutalek SP, Discigil KF, Webb CR, Greenspan AM, Spielman SR. Risks and complications of clinical cardiac electrophysiologic studies: a prospective analysis of 1,000 consecutive patients. J Am Coll Cardiol. 1987;9(6):1261–8. doi: 10.1016/s0735-1097(87)80465-5.
- Chen JY, Chang KC, Lin YC, Chou HT, Hung JS. Safety and outcomes of short-term multiple femoral venous sheath placement in cardiac electrophysiological study and radiofrequency catheter ablation. Jpn Heart J. 2004;45(2): 257–64. doi: 10.1536/jhj.45.257.
- Haman L, Parízek P, Malý R, Duda J, Malý J. Analysis of thrombotic complications after catheter ablation. Acta Medica (Hradec Kralove). 2006;49(1):47–50.
- Moubarak G, Bonhomme S, Vedrenne G, Bouleti C, Ollitrault J, Priollet P, Cador R, Cazeau S. Femoral vein thrombosis after right-sided electrophysiological procedures. J Interv Card Electrophysiol. 2013;38(3):155–8. doi: 10.1007/s10840-013-9832-4.
- Bohnen M, Stevenson WG, Tedrow UB, Michaud GF, John RM, Epstein LM, Albert CM, Koplan BA. Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias. Heart Rhythm. 2011;8(11):1661–6. doi: 10.1016/j.hrthm.2011.05.017.
- Пронин АГ, Валова ОА. Новые возможности оценки уровня Д-димера в диагностике тромбоэмболии легочной артерии у больных хронической сердечной недостаточностью. Журнал им. Н.В. Склифосовского «Неотложная медицинская помощь». 2017;6(3): 216–20. doi: 10.23934/2223-9022-2017-6-3-216-220.
- Булашова ОВ, Малкова МИ. Значение Д-димера в диагностике и прогнозе тромбоэмболических осложнений у кардиологических больных. Практическая медицина. 2012;5(60):81–4.
- Воробьева НМ, Панченко ЕП, Добровольский АБ, Титаева ЕВ. Повышение Д-димера у больных сердечно-сосудистыми заболеваниями без тромбоэмболических осложнений: с чем это связано и что делать? Ангиология и сосудистая хирургия. 2010;16(4): 34–42.
- Добровольский АБ, Титаева ЕВ. Лабораторная диагностика нарушений системы гемостаза – скрининговые тесты. Российский кардиологический журнал. 2015;20(3):52–7. doi: 10.15829/1560-4071-2015-03-52-57.
- Панченко ЕП, Кропачева ЕС. Профилактика тромбоэмболий у больных мерцательной аритмией. М.: МИА; 2007. 144 с.
- Mahé I, Drouet L, Simoneau G, MinhMuzeaux S, Caulin C, Bergmann JF. D-dimer can predict survival in patients with chronic atrial fibrillation. Blood Coagul Fibrinolysis. 004;15(5):413–7. doi: 10.1097/01.mbc.0000114440.81125.bd.
Supplementary files
