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QJM Advance Access originally published online on January 17, 2005
QJM 2005 98(2):139-145; doi:10.1093/qjmed/hci020
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QJM vol. 98 no. 2 © Association of Physicians 2005; all rights reserved.

Lower-limb deep-vein thrombosis in a general hospital: risk factors, outcomes and the contribution of intravenous drug use

F.F. Syed and N.J. Beeching

From the Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK

Received 27 May 2004 and in revised form 1 November 2004

Background: Much of the morbidity associated with deep-vein thrombosis (DVT) is absent from the evidence base used to define best clinical practice. Intravenous (IV) drug use is an increasingly frequent cause of DVT.

Aim: To obtain a profile of DVT patients in routine clinical care, and determine the contribution of IV drug use.

Design: Retrospective case-note review.

Methods: We reviewed 232 episodes of lower-limb DVT in a large district general hospital during 1996.

Results: Patients had mean (range) age 62.8 (21–97) years, with 43.9% aged > 70 years. A large proportion would have been excluded from prospective studies that have contributed to current DVT guidelines. Risk factors included smoking (33.0%), immobility (26.5%), previous DVT (23.6%), surgery in the last 3 months (18.2%), malignancy (16.5%), varicose veins (10.5%) and IV drug use (6.9%). Forty-five (19.4%) had multiple risk factors. Postsurgical DVT commonly presented from the community following initial hospital discharge. Intravenous drug use accounted for 48.4% of episodes in patients aged ≤40 years. Thrombosis was right-sided in 68.8% of IV drug users, compared to 38.2% in others (p = 0.034).

Discussion: Our patients differed from those in most of the prospective studies used to develop routine clinical care pathways for DVT. Intravenous drug use is an important cause of community-acquired DVT in young adults.

Address correspondence to Dr N.J. Beeching, Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP. e-mail: nicholas.beeching{at}rlbuht.nhs.uk


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