Talk:Deep vein thrombosis

message: 
As part of a student assignment, feedback on DVT was posted on a user's talk page: . I believe I have already addressed their concerns with regard to compression stockings, but I'll double check. Biosthmors (talk) 17:13, 30 December 2019 (UTC)
thread_title: Assignment feedback

message: I think that "deep bone thrombosis" (dbt) is the same thing as deep vein thrombosis. I'm not sure, but here is some corroborating text:
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Featured snippet from the web
Deep bone thrombosis, which is clotting in the veins that can cause a range of leg pain – this can become a life threatening illness if not addressed.
...
Other symptoms of PAD include:
    numbness/tingling in the lower legs and feet.
    coldness in the lower legs and feet.
    ulcers or sores on the legs or feet that do not heal.
Leg Pain
https://www.viralegs.com › leg-pain
Web results
Causes of Deep Bone Thrombosis - Graphic Online
https://www.graphic.com.gh › Ghana news Headlines › Health
May 2, 2014 - Dear mirror doctor I am a very active 46-year-old man who drives to and from work with no problems. I noticed a gradual increase in the size of ...
Assessment 2 (1) | Thrombosis | Vein - Scribd
https://www.scribd.com › document › Assessment-2-1
Nov 20, 2017 - Deep vein thrombosis deep bone thrombosis (DVT) is a blood clot thrombosis in a major vein that usually develops in the legs and/or pelvis. 2.
Deep Vein Thrombosis - Its a real issue if you drive too much ...
https://uberpeople.net › Geographical › Australia › Sydney
Feb 21, 2016 - 20 posts - ‎18 authors
... abuse prescription drugs and are actually obese telling us all we have to live healthier. On the Deep bone Thrombosis thing just make sure if ...
Leg Pain
https://www.viralegs.com › leg-pain
Deep bone thrombosis, which is clotting in the veins that can cause a range of leg pain – this can become a life threatening illness if not addressed.
Myumaimah : http://myumaimah.com/
https://myumaimah.com.cutestat.com
... wear compression stockings, compression socks for sale, deep bone thrombosis, varicose vein clinic, jobst compression socks, vertical veins in legs, where to ...
The House That Hugh Laurie Built: An Unauthorized Biography ...
https://books.google.com › books
Paul Challen - 2010 - ‎Biography & Autobiography
Within a minute in their first diagnostic session, House has ruled out the schizophrenia as a cause of the deep bone thrombosis (dbt). Unlike his other patients, ...
Deep Bone Thrombosis is Sexy | Torn Flesh Records
https://tornfleshrecords.bandcamp.com › track › deep-bone-thrombosis-is-...
Deep Bone Thrombosis is Sexy by Torn Flesh Records, released 18 November 2013.
Cafe on the Edge of Outer Space - Page 1 - Google Books Result
https://books.google.com › books
Robert Appleton - 2008 - ‎Interstellar travel
It's a deep-bone thrombosis of stars and gravitational attraction. Body to body, orbit to orbit, me to her. We're cosmic trespassers, and I feel just as transparent as ...
The Complete Testament - Page 1011 - Google Books Result
https://books.google.com › books
BLA BLA BLA, WE COULD NOT STOP GIVING HIM HIS MEDICATION EVEN HE IS SHOWING SIGNS OF DEEP BONE THROMBOSIS, BUT BECAUSE WE ...
Dr. Sunder Narasimhan - General Surgeon - Book ... - Practo
https://www.practo.com › bangalore › doctor › sunder-narasimhan-vascula...
Rating: 88% - ‎154 votes - ‎Price range: ₹700 consultation fee
Filter placement for deep bone thrombosis. ○. Cerucial rib. ○. Thoracic Outlet Syndrome. ○. Arterial Duroubosis. ○. Arterial Occlusion. ○. Mesentric Ischemia.
From https://www.google.com/search?client=firefox-b-1-d&q=%22Deep+bone+thrombosis%22 --User123o987name (talk) 16:21, 31 December 2019 (UTC)
replies: text: It seems to be a misunderstanding/misspelling by people who really mean deep venous thrombosis. Tellingly, there are only 216 Google hits on your search. Most of the hits are not written by healthcare professionals. I did not find the phrase at all in PubMed. Axl ¤ [Talk] 12:18, 2 January 2020 (UTC)
thread_title:  Deep bone thrombosis 

message: Greetings User:Graham Beards. After a long hiatus, I am back to working on this article, which you previously reviewed. Thank you. Because of your comment towards the bottom of Wikipedia:Peer review/Deep vein thrombosis/archive3, I did recently incorporate mention of stroke  and I have been researching the potential impact of heart failure. Regarding heart failure as a risk factor for DVT, I am not yet sure. My current opinion is limited by general internet access. A 2016 systematic review and meta-analysis (), for example, states in the abstract "Many studies have investigated the association between venous thromboembolism and heart failure, but have yielded inconsistent findings" but then concludes "Heart failure is a common independent risk factor for venous thromboembolism". Yet it seems odd to cite this article to support the claim that heart failure is a risk factor for DVT because this study is limited to hospitalized patients, and hospitalization itself is already cited on the article as a DVT risk factor. Also, it could be the case that statistical significance for VTE is demonstrated by pooling DVT and PE data while the statistical significance for DVT might not yet be independently established. Similarly, I saw a 2019 study  where heart failure appears more correlated with isolated PE than DVT with or without PE, called DVT/PE in this study. While the 2016 meta-analysis suggested that their findings could be considered in future prophylaxis regimens, for what it's worth, the most recent 2018 clinical practice guidelines  (that the CDC prominently features on their website) don't have any separate guidance on heart failure patients. I feel a bit lost in the weeds here, but at this point it doesn't seem like a firm fact to call heart failure a risk factor for DVT (unless we operate under the assumption that VTE risk factors are always DVT risk factors). So, should VTE risk factors be cited on the DVT article as DVT risk factors? Biosthmors (talk) 17:07, 2 January 2020 (UTC)
replies: text: The prose of the "Causes" section more or less does this already, I'd say. Also, I did find a more recent open-access study that looked at this issue. It said that "Most, although not all, studies have identified HF as an important risk factor for VTE". It looks like the answer is yes, but it appears to be still in the process of being sorted out by current research. Biosthmors (talk) 13:52, 4 January 2020 (UTC)
replies: text: This study provides some related and interesting reading: "Atrial Fibrillation and Cause-Specific Risks of Pulmonary Embolism and Ischemic Stroke" J Am Heart Assoc. 2018 Jan 29;7(3).  (freely available source) Biosthmors (talk) 18:15, 8 January 2020 (UTC)
thread_title:  Cite heart failure as a DVT risk factor? Bigger question: is it OK to cite VTE risk factors as DVT risk factors? 

message: *economics: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706477/ 
*diagnosis  
*pathophysiology/causes/risk factors:  however (Annals of Translational Medicine redirects to AME Publishing Company which currently says "It was included on Beall's list of predatory publishers, prior to the list being taken offline in January 2017") 
*nonadministration of in-hospital doses (also covered in a 2015 Wall Street Journal article I believe)  and  
*management:  
*FVL paradox: https://ashpublications.org/bloodadvances/article/3/21/3375/422724/Thrombus-stability-explains-the-factor-V-Leiden Biosthmors (talk) 02:24, 18 February 2020 (UTC)
thread_title:  Sources to add  

message: I am currently not sure if all authors are consistent with their definition for iliofemoral DVT. It appears it might either mean proximal DVT,(I previously cited  to support this use but I'm now paywalled), a certain kind of bad proximal DVT that requires involvement of an iliac vein,, or something to be distingished from both femoropopliteal and distal DVT. To be determined. Biosthmors (talk) 19:54, 20 January 2020 (UTC)
replies: text: I've decided to go with the explicit definition provided in 2019 guidelines from Australia and New Zealand as this seems to be the most reliable source to cite so far (particularly since it defines iliofemoral DVT in the context of using catheter-directed thrombolysis). The article has been updated accordingly. Biosthmors (talk) 16:55, 22 January 2020 (UTC)
thread_title:  Uncertainty in definition of iliofemoral DVT 

message: (Relevant diff, which I reverted.) I massively reworked the newly dubbed "Causes and risk factors" section yesterday by subsuming a risk factor subsection into the prose of the causes section. So I renamed the new mega-section "Causes and risk factors." I think this title works better than just picking one (Causes or Risk factors) because the first paragraph is all about causes and a lot of the prose talks about the interplay between specific risk factors and why they contribute to those causes. So in my mind the dual titles work well for this section. That being said, the article is in flux, and there's conceptual overlap with the aforementioned section and the Pathophysiology section. So maybe we'll ultimately find a new and improved re-organization of the text that makes this thread obsolete. Also, maybe I'm missing some collective wisdom. For what it's worth, it does seem like a sentence should be added that explains how DVT risk is conceptualized as multifactorial and begins once a threshold is reached. I recall seeing that in a review article, but I'm not sure if it is cited or not. Biosthmors (talk) 15:46, 28 January 2020 (UTC)
replies: text: I've re-thought this, and I've changed it to just "Causes" since that seems to be the most common thing to do per Wikipedia:Manual_of_Style/Medicine-related_articles#Diseases_or_disorders_or_syndromes. I don't see a loss in quality by not having the word "risk factor" in the section title. Biosthmors (talk) 15:17, 30 January 2020 (UTC)
thread_title:  Causes / risk factors section 

message: *These images of venograms are interesting. But I don't know what they are showing, so I find it confusing. It should be explained if it is going to be used in the article, in my opinion. In other words, I have long found these images distracting and confusing. I moved them here for the time being, and I will ask the author if they will please assist. Biosthmors (talk) 01:18, 29 January 2020 (UTC)
thread_title:  Images 

message: Bed rest appears to be confined to the history books: "The second half of the [20th] century was characterized by the simplification of anticoagulant treatment, which allowed ambulatory treatment of the disease and the end of the bed‐rest dogma". This explains why I trimmed that content out of the treatment section, which was based on 10+ year old medical sources anyhow. The article already establishes that bed rest is a risk factor (causes section) and that walking helps (prevention section). There's plenty of room to discuss bed rest as a historical treatment in the historical section, as the above quoted source does. But there's no need for us to carp to a few hold-out physicians of the 1990s, as it appears the former text was trying to do. Biosthmors (talk) 18:36, 4 February 2020 (UTC)
thread_title:  Bed rest 

message: I cited a recent secondary source for content regarding aspirin. The following studies were previously cited in the DVT article, but I commented them out a while back, and I'm not sure we need to cite them. Perhaps listing them here will help make sure the article is comprehensive:
*
*
* article states recurrent VTE after unprovoked VTE and discontinuation of VKA is about 10% in the first year and about 5% per year thereafter
Biosthmors (talk) 15:50, 18 February 2020 (UTC)
thread_title:  Aspirin 

message: Guideline updated here. Need to review references to CG144 and replace. JFW | T@lk 09:57, 5 May 2020 (UTC)
replies: text: Agreed! That's on my to-do list. Thanks for posting. Biosthmors (talk) 00:55, 7 May 2020 (UTC)
thread_title:  NICE NG158 

message: A discussion is taking place to address the redirect :Deep vein thrombosis in lower limb (NOS). The discussion will occur at Wikipedia:Redirects for discussion/Log/2020 July 13#Deep vein thrombosis in lower limb (NOS) until a consensus is reached, and readers of this page are welcome to contribute to the discussion.  Tom (LT) (talk) 06:58, 13 July 2020 (UTC)
thread_title:  "Deep vein thrombosis in lower limb (NOS)" listed at [[Wikipedia:Redirects for discussion|Redirects for discussion]] 

message: Here we can list sources that might be useful for an updated pathophysiology section:
*
**Ignore highlighting. Henke PK publishes widely in respected journals in this topic area 
* cited & ignore highlighting: cited 72 times in Web of Science as of ~April 1, 2021
* cited
* cited
* cited
*
* cited
* cited
*
* cited
*
* not needed
*
*Other topic: 
*Recent reviews on mechanisms of cancer associated thrombosis also exist
*
**per https://www.scopus.com/sources.uri this journal is rated as 181/331 in oncology. a quick google search shows it has already been cited 17 times. Biosthmors (talk) 11:40, 23 April 2021 (UTC)
thread_title:  Pathophysiology, etc. sources 

message: *
*
**Is "'Idiopathic' catastrophic thrombosis" a synonym for thrombotic storm as currently used in 6th paragraph of this section?
Epidemiology: 
*  cited
* cited
Series of articles in Blood:
* cited, but this article can be expanded upon in terms of what anticoagulants for what condition. For example, when LMWH and not a DOAC?
* cited
*
*
*
Random:
* cited
* cited
*
*
*
Diagnosis:
*
Signs and symptoms:
*
* mentions character of pain, exacerbating factors; also check BMJ citations there seems to be a problem with accurate volume numbers?
Lines of Zahn:
*
Biosthmors (talk) 19:26, 17 March 2021 (UTC)
thread_title:  Other sources 

message: A recent edit added the following text, which I just removed as I have concerns over too-close paraphrasing and duplicative content. Some of it however might be worth adding back "Venous blood clots are structures consisting of successive layers of fibrin, platelets, red bloods cells, and leukocytes. Compared to arterial clots, the number of platelets is relatively low, but platelets do seem to play an important role. It's also worth noting that the use of aspirin may decrease the risk of first and recurrent VTE." Biosthmors (talk) 17:20, 2 April 2021 (UTC)
thread_title:  Pathophysiology edit 

message: This edit might have removed the answer but I haven't seen it discussed yet in more recent reviews. Biosthmors (talk) 18:39, 9 April 2021 (UTC)
thread_title:  How does a DVT clot attach to veins? 

message: In reply to this edit, I've seen a couple reviews mention soleal veins / the soleal vein. The second source discusses the soleal vein in depth. I thought mention of this vein / venous system and a WP:REDlink to it were appropriate. I was thinking since secondary sources mention it, we'd be fine to mention it as well (and that it deserved an article) User:Jfdwolff. Thanks. Biosthmors (talk) 14:42, 11 April 2021 (UTC)
replies: text: Thanks for the clarification. The soleal veins are definitely not the only calf veins where DVTs can originate. From the second reference: "The deep veins of lower limbs are divided into the thigh and calf veins. The calf veins comprise three crural veins (posterior tibial, anterior tibial, and peroneal veins) that receive blood flow from the foot sole and the intramuscular veins (soleal and gastrocnemius veins) and their joint vein (popliteal vein). The thigh veins (iliac and femoral veins) run from the calf veins toward the center. The calf and thigh veins have different anatomical features." Therefore, we should either mention all the veins or none of them. JFW | T@lk 08:15, 12 April 2021 (UTC)
replies: text: I agree with you that "the soleal veins are definitely not the only calf veins where DVTs can originate". But the source has an entire section on "Growth of a Soleal Vein Thrombus", for example. It doesn't do this with any other vein. The first source cites the second (and another) for its sentence that in "most of the lower extremity DVT cases, thrombus formation starts in the soleal veins of the calf and then propagates to other veins". I'm not sure a majority of LEDVT starts in the soleal vein, but saying they often start there appears to be an accurate and appropriately weighted claim. I'm not wedded to this mention of soleal vein(s), however. Biosthmors (talk) 01:17, 13 April 2021 (UTC)
thread_title:  Soleal veins 

message: I excised the following text: Anticoagulation, which increases the risk of bleeding, is sometimes used indefinitely (lifelong treatment) in those with a high-risk for recurrence. The risk of major bleeding with long-term anticoagulation is about 3% per year, and the point where annual VTE risk is thought to warrant long-term anticoagulation is estimated to be between 3 and 9%. Usually, only when individuals exceed a 9% annual VTE risk is long-term anticoagulation a common consideration. For example, antithrombin deficiency, a strong or moderately strong risk factor, carries an annual risk of VTE of only 0.8–1.5%; as such, asymptomatic individuals with thrombophilia do not warrant long-term anticoagulation.Guyatt et al. 2012, p. 11S: 7.1.  The logic of this text is predominantly based upon the use of warfarin. However, anticoagulation now, warfarin or DOACs, has more complicated and differing risk profiles. For example: "... the consequences of a major bleed are generally worse than the consequences of a recurrent VTE: about 12% of major bleeds (probably lower with direct oral anticoagulants [DOACs] than with warfarin10 ), as opposed to 4% of recurrent VTE, are fatal (∼3:1 ratio).3,9,11-13" From . Biosthmors (talk) 06:33, 16 April 2021 (UTC)
thread_title:  Outdated text 

message: I removed the following: Signs and symptoms alone are not sufficiently sensitive or specific to make a diagnosis, but when considered in conjunction with pre-test probability, can help determine the likelihood of DVT. and simplified the content for the signs and symptoms section. I'm currently thinking the diagnosis section should mention and link pre-test probability at the beginning. Biosthmors (talk) 15:38, 22 April 2021 (UTC)
thread_title:  Pre-test probability 

message: The page refers to VTE that can relate to either DVT or PE which is backed up by ref used, but other refs and the entry page for VTE says that VTE is the combination of DVT and PE. This needs to be addressed maybe by adding 'some sources...' etc. 
--Iztwoz (talk) 09:50, 25 April 2021 (UTC)
replies: text: Thank you for your edits Iztwoz. I see sources say that DVT and PE comprise VTE. But this just means (as I understand it) that VTE = either DVT, PE, or DVT + PE. I'm unaware of sources that say VTE is only DVT + PE. Even if we found one, I think the preponderance of sources are clear on this. With regards to this diff, the supporting sentence is "Thrombosis at unusual sites accounts for ∼10% of all cases of venous thrombosis, affecting any venous region other than the deep or superficial veins of the lower limbs or those involved in pulmonary circulation." (And just to compare the incidence of superficial vein thrombosis with VTE I found this and they are comparable [both are around 1 to 2 per thousand person years].) I also made a clarifying edit at venous thrombosis. In an ideal world, perhaps there would be a parent article at venous thromboembolism for DVT, DVT + PE, and PE. The article at venous thrombosis should really be a parent article to all forms of venous thrombosis. I don't like the current venous thrombosis page because focuses too heavily on VTE, but I believe that's also (perhaps mainly) my fault. Biosthmors (talk) 11:37, 25 April 2021 (UTC)
replies: text: Thanks Biosthmors I admit to a bias for defining venous thromboembolism as comprising both DVT and PE - as per Harrison's for one. A clot in a vein - DVT - is a clot in a vein....it is only a thromboembolism when it or part of it detaches and travels in the bloodstream or what am I misunderstanding?  That aside I feel that there is too much coverage of VTE and PE when the entry page is DVT.? These days I can only fit in a few edits mostly when am very tired. --Iztwoz (talk) 19:38, 25 April 2021 (UTC)
replies: text: This is copied from Venous thrombosis page - "When a blood clot breaks loose and travels in the blood, this is called a venous thromboembolism (VTE). The abbreviation DVT/PE refers to a VTE where a deep vein thrombosis (DVT) has moved to the lungs (PE or pulmonary embolism).--Iztwoz (talk) 19:54, 25 April 2021 (UTC)
replies: text: I understand the concern. In my mind it makes sense that Wikipedia might contradict itself, because sources appear to contradict one another as well. I found this public-facing website of an organization that hosts medical journals, and it says VTE = DVT + PE. (But would they agree if you pressed them that they really mean and/or?) I went to a new guideline-based journal article to see what they say and the first sentence says "Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important cause of morbidity and mortality among patients with cancer.": from . I've asked a couple Wikipedian physicians (one is already participating) to take a look at the ongoing peer review for DVT. Maybe they'll chime in. For what it's worth, NICE opts for the term venous thromboembolic diseases in reference to DVT and PE. Thanks for your efforts! A lot of the data generated for DVT is under the rubric of VTE so yes, sometimes this article is more generalist than specific at times. Biosthmors (talk) 20:16, 25 April 2021 (UTC)

text: I looked up Harrison's (the same one?) and it said "Venous thromboembolism (VTE) encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE)..." I interpret that to mean DVT, PE, or DVT + PE. Hope this all helps. I hope you get some rest! Biosthmors (talk) 20:22, 25 April 2021 (UTC)
replies: text: I read it as it says - VTE comprises DVT and PE, as other surces also say and this does not need anybody's interpretation. A pulmonary embolism on its own cannot be considered to be specifically a venous thromboembolism since it may also be caused by an air bubble or a part of an atherosclerotic plaque.see --Iztwoz (talk) 12:17, 28 April 2021 (UTC)
replies: text: Robbins makes the distinction of Pulmonary thromboembolism. Another way of looking at the definition is the description of a pulmonary embolism caused by a deep vein thrombosis.--Iztwoz (talk) 15:23, 28 April 2021 (UTC)
replies: text: Changed wording a bit and added refs - I shall leave the rest now for JFW's review. Best--Iztwoz (talk) 17:06, 28 April 2021 (UTC)
replies: text: I was looking for a journal article to replace the book/website references and the first journal article I opened prompted me to instead excise one of the contributions FYI. The rationale is in the edit summary. Best. Biosthmors (talk) 23:21, 2 May 2021 (UTC)
thread_title:  Lack of clarity for VTE 

message: Prompted by Wikipedia:Peer review/Deep vein thrombosis/archive4, I removed the following text from the Classification section because I think it wouldn't be useful for readers. These distinctions are either hardly drawn or absent in the article: DVT that has no symptoms, but is found only by screening, is labeled asymptomatic or incidental.
And this will be a good source to help give context to the different classifications of proximal DVT:  Biosthmors (talk) 14:27, 13 May 2021 (UTC)
thread_title:  Classification section  

message: Pregnancy is associated with an increase in fibrinogen and D-dimer levels, so this test is less useful. This should probably be mentioned in the diagnosis section. I've heard of age-adjusted D-dimer levels in the workup of PE, but I don't recall ever seeing that applied to DVT. Biosthmors (talk) 17:52, 25 May 2021 (UTC)
thread_title:  Pregnancy 

message: I'm not sure this addition adds anything to the article. It's 9 years old, so it's likely outdated, and it doesn't add anything to the article in my opinion. I seriously doubt the recent seminar on VTE in the Lancet cited this article. The questions Cochrane articles attempt to answer (in my opinion) don't often cleanly lend themselves towards generating useful prose. This article has only been cited ~24 times in the last 9 years. Others seem to agree. Biosthmors (talk) 02:10, 4 August 2021 (UTC)
thread_title:  2012 cochrane source recently added 

message: Selective estrogen receptor modulators can be added as a risk factor. Biosthmors (talk) 22:04, 1 August 2022 (UTC)
replies: text: WP:MEDRS evidence? Zefr (talk) 02:37, 2 August 2022 (UTC)
replies: text: Abounds Biosthmors (talk) 00:10, 5 August 2022 (UTC)
replies: text: That's a 13 year old preliminary study. We use reviews - a MEDRS systematic review, meta-analysis, or position statement by a clinical organization within the past 5 years - see WP:MEDSCI. Don't think it exists - see this. Zefr (talk) 01:01, 5 August 2022 (UTC)
replies: text: Zefr, I am familiar with how to source medical articles on Wikipedia. I saw this brought up in a practice board question, so I am assuming it is well-described in the literature. It makes sense, since it is well known that estrogen (think birth control types) increases the risk of VTE. I found a review that states the following regarding tamoxifen (a SERM): "Chemotherapy further heightened the risk of VTE (~ 10-fold higher compared to who did not receive chemotherapy) in patients with metastatic BC [8, 30]. Among hormonal therapies, tamoxifen carried the highest risk which could increase the risk of VTE up to sevenfold, followed by aromatase inhibitors [32]." I am not proposing any specific text for the article at this point. But tamoxifen being an established risk factor appears well-known, as it is mentioned in the abstract of . Also, the abstract of a 2015 review  states the risk is increased with most SERMs, so based on that I will concede that my original post is overly-simplistic and likely overstated. But still, the phenomenon I reference appears to be well-known. Biosthmors (talk) 19:46, 20 August 2022 (UTC)
thread_title:  Selective estrogen receptor modulator 

message: An expert told me HHS was a risk factor today. I see it confirmed in Western populations thus far. Biosthmors (talk) 23:38, 4 November 2022 (UTC)
replies: text: VTE is a well-known complication of HHS (not just DVT). Should be easy to source. JFW | T@lk 09:50, 6 November 2022 (UTC)
thread_title:  HHS