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Design and Retrospective Application of a Spine Trauma DVT Prophylaxis Protocol on Level 1 Trauma Center Patient Database.

Global Spine J 2021 Apr 20:2192568220979139. Epub 2021 Apr 20.

22683Baylor University Medical Center, Dallas, TX, USA.

Study Design: Systematic literature review.

Objectives: The impact of thromboembolic disease on the morbidity and mortality of patients with acute spinal cord injury is well documented, with rates as high as 67%-100% among untreated patients. The efficacy of mechanical prophylaxis as a stand-alone measure has been questioned, so we sought to determine a safe perioperative window for chemical anticoagulation use after spine surgery. Read More

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Symptomatic bilateral massive pulmonary embolism and proximal and distal deep vein thrombosis following arthroscopic meniscus surgery: A case report.

Medicine (Baltimore) 2021 Apr;100(13):e25372

Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Rationale: The incidence of venous thromboembolism (VTE) after knee arthroscopy is remarkably lower than that of arthroplasty. We describe a patient with symptomatic bilateral massive pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) in the femoral and popliteal veins after arthroscopic meniscus repair surgery.

Patient Concerns: The patient underwent arthroscopic meniscus repair with no intraoperative complication. Read More

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Paget-Schroetter Syndrome in a Young Female.

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:23247096211003263

Ashland Bellefonte Cancer Center, Ashland, KY, USA.

Paget-Schroetter syndrome or effort thrombosis is a relatively rare primary spontaneous thrombosis of upper extremity deep veins secondary to entrapment of axillary subclavian veins from an abnormality of the thoracic outlet. It is commonly seen in young adults who lift heavy weights or strenuous use of the upper extremities during athletic activities. Repetitive microtrauma to the subclavian vein secondary to narrow costoclavicular space and strenuous activities leads to intimal layer inflammation, hypertrophy, fibrosis, and coagulation cascade activation. Read More

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Improving compliance of risk assessment and nonpharmacological interventions for deep venous thrombosis prevention in a respiratory ICU: a best practice implementation project.

JBI Evid Implement 2020 Dec 5. Epub 2020 Dec 5.

1Huiqiao Medical Center, Nanfang Hospital, Southern Medical University 2Nanfang Nursing Centre for Evidence-Based Practice: A JBI Centre of Excellence 3Respiratory Department, Nanfang Hospital, Southern Medical University, Guangzhou, China 4Transfer Science Department, Faculty of Health and Medical Sciences, Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia 5Nursing Department, Nanfang Hospital, Southern Medical University, Guangzhou, China *Jinyan Wu and Shunfang Zhu contributed equally to this article and share first authorship.

Objectives: To increase the compliance with deep venous thrombosis (DVT) nonpharmacologic prophylaxis best practice recommendations while ensuring appropriate and structured nonpharmacologic prophylaxis for patients in the respiratory ICU.

Background: DVT is a major problem for patients, with those who are critically ill representing a high-risk population for developing the condition. Nonpharmacologic prophylaxis is considered an effective intervention. Read More

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December 2020

Prevalence of Venous Thromboembolism in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis.

Front Cardiovasc Med 2020 8;7:598846. Epub 2021 Jan 8.

Department of Hematology, Hamad Medical Corporation, Doha, Qatar.

Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Read More

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January 2021

[Cinematic Rendering in Cone Beam Computed Tomography: Advanced 3D Reconstructions of Dental and Maxillofacial Pathologies].

Swiss Dent J 2021 Feb;131(2):133-139

Klinik für Neuroradiologie, Universitätsspital Zürich, Schweiz.

Cinematic rendering (CR) is a novel 3D visualisation technique, which provides photorealistic image reconstructions with a high level of image details. Aim of this case series is to show the application of CR in Cone Beam Computed Tomography (CBCT) in dentomaxillofacial pathologies. Four exemplary CBCTs of clinical dentomaxillofacial cases were selected. Read More

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February 2021

Venous Adventitial Cyst Mimicking a Persistent Femoral Deep Venous Thrombosis.

Ann Vasc Surg 2021 Jan 27. Epub 2021 Jan 27.

Department of Vascular and Endovascular Surgery, Royal Perth Hospital, Perth, Australia.

Objective: We describe the case of lower limb unilateral swelling due to a cystic mass (adventitial cystic disease) compressing on the common femoral vein. This was misdiagnosed as a deep vein thrombosis on both computed tomography venography and Doppler ultrasound.

Method: We describe the diagnostic pathways and surgical excision of this venous adventitial cyst of the femoral vein. Read More

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January 2021

Sex-related differences in D-dimer levels for venous thromboembolism screening.

Acad Emerg Med 2021 Jan 26. Epub 2021 Jan 26.

Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA.

Background: D-dimer is generally considered positive above 0.5 mg/L irrespective of sex. However, women have been shown to be more likely to have a positive D-dimer after controlling for other factors. Read More

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January 2021

Postoperative spinal epidural hematoma following therapeutic anticoagulation: case report and review of literature.

J Spine Surg 2020 Dec;6(4):743-749

Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.

While the incidence and risk factors of pulmonary embolism (PE) and deep vein thrombosis (DVT) following spinal surgery have been well studied, the treatment of such thromboembolic disease in patients after spine surgery remains controversial. When initiating therapeutic anticoagulation after spine surgery, clinicians must weigh the catastrophic risk of a PE against the risk of bleeding complications associated with anticoagulation therapy. Here we report the case of a 56-year-old male who presented with symptoms of spinal cord compression secondary to metastatic renal cell carcinoma (RCC). Read More

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December 2020

Emergency Department Visits After Total Joint Arthroplasty for Concern for Deep Vein Thromboses.

J Am Acad Orthop Surg 2021 Jan 13. Epub 2021 Jan 13.

From the Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Grosso, Chisari, Vannello, Hozack), and the Connecticut Joint Replacement Institute, Hartford, CT (Grosso).

Background: Concern for deep vein thrombosis (DVT) is the most common reason for emergency department (ED) referral after total joint arthroplasty (TJA) at our institution. We aim to investigate the referral pathway, together with the cost and outcomes associated with patients who access an ED because of concern for DVT after TJA.

Methods: We reviewed a consecutive series of all primary hip and knee arthroplasty patients who accessed the ED for concern for DVT within 90 days of surgery over a one-year period. Read More

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January 2021

Pathway for the diagnosis and management of pulmonary embolism.

Crit Pathw Cardiol 2021 Jan 11. Epub 2021 Jan 11.

Department of Cardiology, Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel Department of Medicine, Mount Sinai Morningside, New York, NY, USA Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Venous thromboembolism (VTE), the combined syndromes of deep vein thrombosis (DVT) and pulmonary embolism (PE), is currently the third most frequent acute cardiovascular syndrome globally behind myocardial infarction and stroke. PE carries substantial mortality. In the past decade we have seen a remarkable improvement in new diagnostic tools as well as advances in therapeutic options to manage patients with PE. Read More

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January 2021

Cauda equina syndrome secondary to portal vein thrombosis: case report of favorable outcome with conservative treatment.

J Neurosurg Spine 2021 Jan 1:1-6. Epub 2021 Jan 1.

1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and.

Epidural varicosis is a rare though well-known cause of cauda equina syndrome (CES). Although inferior vena cava (IVC) obstruction is the most common finding in such cases, portal vein hypertension can lead to epidural venous plexus engorgement by means of lumbar portocaval shunt activation.A 40-year-old woman presented with right-sided sciatica, which progressed to right foot drop and a 3-day history of vesical tenesmus and fecal retention. Read More

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January 2021

A Review of Pathophysiology, Clinical Features, and Management Options of COVID-19 Associated Coagulopathy.

Shock 2020 Dec 29;Publish Ahead of Print. Epub 2020 Dec 29.

Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905 Department of Hematology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905 Division of Vascular Cardiology, Department of Cardiovascular Disease, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905.

Abstract: There is increasing evidence that novel coronavirus disease 2019 (COVID-19) leads to a significant coagulopathy, a phenomenon termed "COVID-19 associated coagulopathy". COVID-19 has been associated with increased rates of both venous and arterial thromboembolic events, a source of significant morbidity and mortality in this disease. Further evidence suggests a link between the inflammatory response and coagulopathy associated with COVID-19. Read More

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December 2020

How to screen and diagnose deep venous thrombosis (DVT) in patients hospitalized for or suspected of COVID-19 infection, outside the intensive care units.

J Med Vasc 2020 Dec 4;45(6):334-343. Epub 2020 Sep 4.

Unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF04), hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), 1, avenue Claude-Vellefaux, 75010 Paris, France; IRSL, EA-3518, recherche clinique appliquée à l'hématologie, université de Paris, 75010 Paris, France; Department of medicine, McGill university, Montreal, QC, Canada. Electronic address:

Introduction: The Coronavirus disease-2019 outbreak (COVID-19) has been declared a pandemic by the World Health Organization. Studies report both a severe inflammatory syndrome and a procoagulant state in severe COVID-19 cases, with an increase of venous thromboembolism, including pulmonary embolism (PE) and deep vein thrombosis (DVT). In this context, we discuss the use of doppler ultrasonography (DUS) in the screening and diagnosis of DVT in ambulatory and hospitalized patients with, or suspected of having, COVID-19, outside the intensive care unit (ICU). Read More

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December 2020

Incidence of deep venous thrombosis in COVID-19 hospitalized patients during the first peak of the Italian outbreak.

Phlebology 2020 Nov 26:268355520975592. Epub 2020 Nov 26.

Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Objectives: A high rate of thrombotic events has been reported in COVID-19 population. The study aims to assess the incidence of deep vein thrombosis (DVT) in COVID-19 patients admitted to a single tertiary hospital.

Methods: From April 2nd to April 18th, 2020, hospitalized patients with SARS-CoV-2 infection were screened by lower limb duplex ultrasound (DUS). Read More

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November 2020

Effect of thrombophilia on clinical outcomes of chronic post-thrombotic patients after iliofemoral stenting with nitinol venous stents.

J Vasc Surg Venous Lymphat Disord 2020 Nov 10. Epub 2020 Nov 10.

Cardiovascular Division, Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Science, Guy's and St Thomas' NHS Trust, King's College London, London, United Kingdom. Electronic address:

Objective: Thrombophilia is a prothrombotic condition that increases the risk of venous thromboembolism. It is unclear whether the presence of thrombophilia alters the clinical outcomes after deep venous stenting. The aim of the present study was to examine the relationship between thrombophilia and outcomes after stenting for post-thrombotic syndrome. Read More

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November 2020

Perioperative Blood Transfusions Are Associated with a Higher Incidence of Thromboembolic Events After TKA: An Analysis of 333,463 TKAs.

Clin Orthop Relat Res 2021 Mar;479(3):589-600

A. J. Acuña, L. T. Samuel, A. K. Emara, A. F. Kamath, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.

Background: Given the morbidity, mortality, and financial burden associated with venous thromboembolism (VTE) after TKA, orthopaedic providers continually seek to identify risk factors associated with this devastating complication. The association between perioperative transfusion status and VTE risk has not been thoroughly explored, with previous studies evaluating this relationship being limited in both generalizability and power.

Questions/purposes: Therefore, we sought to determine whether perioperative transfusions were associated with an increased risk of (1) pulmonary embolism (PE) or (2) deep vein thrombosis (DVT) after primary TKA in a large, multi-institutional sample. Read More

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Lessons Learned: Using the Caprini Risk Assessment Model to Provide Safe and Efficacious Thromboprophylaxis Following Hip and Knee Arthroplasty.

Clin Appl Thromb Hemost 2020 Jan-Dec;26:1076029620961450

Syosset Hospital, Northwell Health, Syosset, NY, USA.

Two of the more common potential complications after arthroplasty are venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), and excess bleeding. Appropriate chemoprophylaxis choices are essential to prevent some of these adverse events and from exacerbating others. Risk stratification to prescribe safe and effective medications in the prevention of postoperative VTE has shown benefit in this regard. Read More

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November 2020

Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.

JAMA 2020 Nov;324(17):1765-1776

Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Importance: Incidence rates for lower extremity deep vein thrombosis (DVT) range from 88 to 112 per 100 000 person-years and increase with age. Rates of recurrent VTE range from 20% to 36% during the 10 years after an initial event.

Observations: PubMed and Cochrane databases were searched for English-language studies published from January 2015 through June 2020 for randomized clinical trials, meta-analyses, systematic reviews, and observational studies. Read More

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November 2020

Incidence of Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Effect on Mortality.

TH Open 2020 Oct 28;4(4):e309-e317. Epub 2020 Oct 28.

Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California, Davis School of Medicine, Sacramento, California, United States.

The cumulative incidence, risk factors, rate of subsequent venous thromboembolism (VTE) and bleeding and impact on mortality of isolated upper extremity deep vein thrombosis (UE DVT) in acute leukemia are not well-described. The California Cancer Registry, used to identify treated patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) diagnosed between 2009 and 2014, was linked with the statewide hospitalization database to determine cumulative incidences of UE DVT and subsequent VTE and bleeding after UE DVT diagnosis. Cox proportional hazards regression models were used to assess the association of UE DVT on the risk of subsequent pulmonary embolism (PE) or lower extremity deep vein thrombosis (LE DVT) and subsequent bleeding, and the impact of UE DVT on mortality. Read More

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October 2020

Deep Vein Thrombosis Secondary to Extrinsic Compression: A Case Report.

Cureus 2020 Oct 25;12(10):e11160. Epub 2020 Oct 25.

Interventional Radiology, Cape Fear Valley Medical Center, Fayetteville, USA.

May-Thurner syndrome (MTS) is defined as extrinsic venous compression by the arteries of the iliocaval system. The most common manifestation of MTS is compression of the left common iliac vein by the right common iliac artery. May-Thurner syndrome is pathologically seen in 2%-5% of patients presenting with symptomatic deep vein thrombosis (DVT). Read More

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October 2020

Virtual risk assessment pathway for deep venous thrombosis: a preliminary model.

Postgrad Med J 2020 Oct 28. Epub 2020 Oct 28.

Department of Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK.

Background: COVID-19 has necessitated the reduction in conventional face-to-face patient consultation to reduce the risk of novel coronavirus SARS-CoV-2 transmission. Traditional pathways to risk assess for deep venous thrombosis (DVT) would involve face-to-face assessment to formulate an appropriate management plan following an initial presentation usually in secondary care or in-hospital settings. Appropriate antithrombotic measures can prevent complication of DVT such as pulmonary embolism with prompt early diagnosis and treatment. Read More

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October 2020

Diagnosis and Treatment of Deep Vein Thrombosis in the Emergency Department: Results of an Italian Nominal Group Technique Study.

Clin Appl Thromb Hemost 2020 Jan-Dec;26:1076029620959720

Internal and Vascular Medicine-Stroke Unit, 9309University of Perugia, Perugia, Italy.

Early diagnosis and treatment of deep vein thrombosis (DVT) is a main issue in the Emergency setting. With the aim of assisting clinicians in the diagnosis and the subsequent management of DVT in the Emergency Departments, a Nominal Group Technique (NGT) study was conducted. A panel of 5 Italian experts developed 21 consensus statements based on available evidence and their clinical experience. Read More

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October 2020

Diagnosis, Clinical Characteristics, and Treatment Modalities of Adolescent May-Thurner Syndrome-associated Deep Venous Thrombosis.

J Pediatr Hematol Oncol 2021 Apr;43(3):e346-e350

Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers.

May-Thurner syndrome (MTS) predisposes individuals to develop lower extremity deep venous thrombosis (DVT) because of compression of the left common iliac vein. Diagnosis of the anatomic obstruction is critical for effective therapy, as treatment by interventional radiology is often required in addition to anticoagulation to prevent thrombus progression and recurrence. The authors performed a retrospective review of adolescent patients who presented with MTS-associated DVT at a pediatric tertiary care center from 2009 to 2018 to assess for delays in MTS diagnosis after the presentation. Read More

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Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery.

Knee Surg Relat Res 2020 Sep 22;32(1):49. Epub 2020 Sep 22.

Trauma & Orthopaedic Department, Royal Blackburn Hospital, Blackburn, UK.

Background: Serum D-dimer is frequently used to rule out a diagnosis of venous thromboembolism (VTE), a recognised complication following total knee replacement (TKR). TKR is known to cause a rise in D-dimer levels, reducing its specificity. Previous studies have demonstrated that D-dimer remains elevated within 10 days of TKR and therefore should be avoided. Read More

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September 2020

Usefulness of computed tomography venography in gynecologic cancer patients with lower extremity edema.

Medicine (Baltimore) 2020 Sep;99(37):e21818

Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Lower extremity (LEx) edema is a common complication in gynecologic cancer patients. There are 2 main causes of edema in these patients such as deep vein thrombosis (DVT) and lymphedema. Early diagnosis and treatment of DVT are certainly important, but it is often difficult to evaluate proximal DVT by using ultrasound. Read More

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September 2020

Massive pulmonary thromboembolism combined with transient thyrotoxicosis in an 18 year old girl.

Clin Hypertens 2020 1;26:17. Epub 2020 Sep 1.

Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-Ro, Womni-Gu, Bucheon-Si, Gyunggi-Do 14647 Republic of Korea.

Background: Pulmonary thromboembolism (PTE) is thought to usually stem from deep vein thrombosis (DVT). However, evidence of DVT could not be found in many cases. Furthermore, transient thyrotoxicosis is a rare but potentially life-threatening emergency involving a systemic hypercoagulable state. Read More

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September 2020

ETNA VTE Europe: A contemporary snapshot of patients treated with edoxaban in clinical practice across eight European countries.

Eur J Intern Med 2020 12 18;82:48-55. Epub 2020 Aug 18.

Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy. Electronic address:

Introduction: Edoxaban has proven its efficacy and safety in the ENGAGE AF-TIMI 48 and HOKUSAI-VTE clinical trials. Clinical practice patients, however, may differ from those enolled in clinical trials. We aimed to compare patients from the HOKUSAI-VTE clinical trial with those treated in clinical practice. Read More

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December 2020

Deep vein thrombosis protocol optimization to minimize healthcare worker exposure in coronavirus disease-2019.

J Vasc Surg Venous Lymphat Disord 2021 03 11;9(2):299-306. Epub 2020 Aug 11.

Department of Radiology, Massachusetts General Hospital, Boston, Mass.

Objective: There are no societal ultrasound (US) guidelines detailing appropriate patient selection for deep vein thrombosis (DVT) imaging in patients with COVID-19, nor are there protocol recommendations aimed at decreasing exposure time for US technologists. We aimed to provide COVID-19-specific protocol optimization recommendations limiting US technologist exposure while optimizing patient selection.

Methods: A novel two-pronged algorithm was implemented to limit the DVT US studies on patients with COVID-19 prospectively, which included direct physician communication with the care team and a COVID-19-specific imaging protocol was instated to reduce US technologist exposure. Read More

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Inferior Vena Cava Filters: Past, Present, and Future.

Chest 2020 Dec 11;158(6):2579-2589. Epub 2020 Aug 11.

Division of Pulmonary Sciences and Critical Care, University of Colorado School of Medicine, Aurora, CO.

Inferior vena cava (IVC) filters have existed as a treatment option for VTE for decades. Advances in medical technology have provided physicians with several options for devices that can be placed on either a permanent or temporary basis; however, there are limited data from randomized, controlled trials on the appropriate use of IVC filters. This contemporary review summarizes the history of IVC filters and the types that are available in clinical practice. Read More

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December 2020