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Thromb Haemost
DOI: 10.1055/a-2595-5458
Stroke, Systemic or Venous Thromboembolism

Predictors, Incidence, and Proximal Extension Rate of Distal Deep Vein Thrombosis in Internal Medicine Wards: Insights from the AURELIO Study

Lorenzo Loffredo 
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Enrico Maggio
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Arianna Magna
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Gianpaolo Vidili
2   Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
,
Angela Sciacqua
3   Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Catanzaro, Italy
,
Chiara Cogliati
4   Department of Internal medicine, L. Sacco Hospital, ASST-fbf-Sacco, Milan, Italy
,
Sciaila Bernardini
5   Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
,
Alessia Fallarino
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Ilaria Maria Palumbo
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Arianna Pannunzio
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Chiara Bagnato
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Nausica Polisena
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Carla Serra
6   Interventional, Diagnostic and Therapeutic Ultrasound Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Lorenzo Falsetti
7   Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
,
Vincenzo Zaccone
8   Internal and Subintensive Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
,
Evaristo Ettorre
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Giovambattista Desideri
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Luca Santoro
9   Catholic University of the Sacred Heart, Rome, Italy
,
Vito Cantisani
10   Department of Radiology, Oncology and Pathology, Sapienza University of Rome, Roma, Italy
,
Pasquale Pignatelli
1   Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Angelo Santoliquido
9   Catholic University of the Sacred Heart, Rome, Italy
,
Francesco Violi 
11   Department of Radiology, Sapienza University of Rome, Roma, Italy
,
AURELIO Study Group› Author Affiliations
Funding This study was supported by a grant from the University of Rome “La Sapienza” (Università degli Studi di ROMA “la Sapienza” Progetti di COOPERAZIONE E SVILUPPO 2021 to LL).
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Abstract

Background

Distal deep venous thrombosis (DDVT) is a clinical condition that can affect patients hospitalized in internal medicine wards and may result in pulmonary embolism. However, many aspects of distal thrombosis in hospitalized medical patients remain poorly understood.

Objective

This study aimed to evaluate the rate of asymptomatic DDVT at admission, the occurrence of DDVT during hospitalization, and to analyze the factors associated with thrombotic events.

Methods

A multicenter, prospective observational study (AURELIO) was conducted across eight centers affiliated with the Ultrasound Study Group of the Italian Society of Internal Medicine. Venous ultrasound of the lower limb veins was performed within 48 hours of admission and at discharge to diagnose distal deep vein thrombosis.

Results

Among 1,458 patients (721 males and 737 females; mean age 71 ± 16 years), asymptomatic distal thrombosis was detected in 59 patients (4%) upon admission. Of these, 47% (n = 28) were classified as isolated DDVT, while 31 cases involved DDVT that extended to the proximal tract. At discharge, 9 additional cases of distal thrombosis were identified, bringing the total to 68 cases. Of these, 46% were DDVT, while 54% DDVT extended to the proximal venous system. Multivariate analysis identified reduced mobility (p = 0.036) and active malignancy (p = 0.02) as independent risk factors for DDVT extending to the proximal tract. Additionally, pneumonia (p = 0.043) and active malignancy (p = 0.008) were associated with DDVT.

Conclusion

The study emphasizes the high prevalence of DDVT in hospitalized patients and the risk of proximal extension. Ultrasound screening should be considered for oncology patients and those with pneumonia to ensure early diagnosis and timely anticoagulant therapy.

Keywords

distal vein thrombosis - ultrasound analysis - medical patients

Authors' Contribution

L.L. is the guarantor of the content of the manuscript, including the data and analysis. Study concept and design: L.L. and F.V. Acquisition, analysis, and interpretation of data: L.L., G.V., C.C., E.M., A.M., A.S., S.B., A.F., I.M.P., A.P., C.B., N.P., C.S., L.F., V.Z., E.E., G.D., L.S., V.C., and P.P. Drafting of the manuscript: F.V. and L.L. Critical revision of the manuscript for important intellectual content: A.S., P.P., F.V., and L.S. Statistical analysis: L.L. and E.M. Study supervision: L.L. All the authors have read and approved the final manuscript.


* The details of the AURELIO study group are mentioned in the Supplementary Material (available in the online version).


Supplementary Material



Publication History

Received: 07 March 2025

Accepted: 27 April 2025

Accepted Manuscript online:
28 April 2025

Article published online:
16 May 2025

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