Introduction: Venous thromboembolic disease (VTE) is an anatomical and clinical entity characterized by the formation of a blood clot (thrombus) that blocks a vein and impedes blood circulation. The most common manifestations are deep vein thrombosis, which usually occurs in the lower limbs, and pulmonary embolism. Our objective was to contribute to the improvement of the management of thromboembolic diseases in the Cardiology department of the National Ignace-Deen Hospital. 

Material and method: It was a longitudinal descriptive prospective study lasting 6 months.

Result: The hospital frequency in our study was 14.28%. The age group 45 to 55 years was the most represented, with a female predominance, at 64.51%. Among the 31 cases of VTE, 7 patients (22.58%) had isolated DVT, 21 patients (61.74%) had PE without prior diagnosis of venous thrombosis and 3 patients (9.68%) had venous thrombosis complicated by pulmonary embolism. Edema and pain in the lower limb were the predominant clinical manifestation of DVT, 29.03%. Tachycardia, dyspnea and chest pain were almost constant in the EP, i.e. 100%; 9.68% of patients presented complications such as pulmonary embolism with hemodynamic instability.

Conclusion: According to this study, VTE affects women and subjects between 45 and 55 years much more.

Venous thromboembolic disease (VTE) is a unique entity that includes two clinical forms: deep vein thrombosis (DVT) and its major complication, pulmonary embolism (PE) [1]. Deep vein thrombosis is inseparable from pulmonary embolism (immediate complication), since 70% to 90% of pulmonary embolisms are consecutive to deep vein thrombosis. [2].

VTE is a common and potentially life-threatening condition.  Due to its impact on morbidity and mortality and medical costs, VTE still represents a major public health issue [1]

The global prevalence is estimated at 1.6 per 1000 inhabitants [3]. According to estimates made at the 1997 Consensus Conference on Prevention of Venous Thromboembolic Events, the annual incidence of DVT was 160/100,000, that of symptomatic (non-fatal) PE was 20/100,000 and that of fatal (post-mortem) of 50/100 000 [4].

In sub-Saharan Africa, it constitutes a real public health problem with a prevalence between 2.7 and 9.12% [5]. However, some studies carried out in a hospital setting give prevalence varying from one country to another. In Senegal, the prevalence of deep vein thrombosis was 2,78% [6]; it was 1.6% in Cameroon [7]. A study conducted in Bamako in 2015 (published in 2019) revealed that VTE constituted 4.02% of hospitalizations in the cardiology department of the Gabriel TOURE hospital [8].

It also presents late complications such as post-thrombotic venous disease and post-embolic pulmonary arterial hypertension [9,10].

In view of these data, we have initiated this study with the aim of evaluating the epidemic-clinical, paraclinical, and therapeutic aspects of venous thromboembolic disease in the cardiology department of the Ignace Deen national hospital.

II-1-Nature, framework and period of the study:

It was a descriptive prospective study conducted in the cardiology department of the Ignace Deen University Hospital Center, over a period of six (6) months from March 1 to September 30, 2024.

II-2 Selection criteria and diagnosis of VTE

 Were included in our study:

All patients hospitalized for imaging-confirmed venous thromboembolic disease. We used the pulmonary angioscanner for the diagnosis of pulmonary embolism and the venous Doppler ultrasound of the lower limbs for venous thrombosis of the lower limbs.

The thoracic angioscanner was performed immediately in patients who had high clinical probabilities assessed by the revised Geneva score and after positive D-Dimer assay in patients with low and intermediate clinical probabilities.

Patients who did not perform a thoracic mangowran and/or venous Doppler ultrasound of the lower limbs were excluded. 

II.3 Study variables

Our study variables were qualitative and quantitative and focused on sociodemographic, clinical, paraclinical, and therapeutic data.

II.3.1 socio-demographic variables: concern age and sex.

II.3-2 clinical variables: all the patients included benefited from an interrogation and a clinical examination to research:

• On the one hand: signs in favor of a DVT such as pain, unilateral swelling, local heat in the lower limb, the sign of Homans and the estimation of the clinical probability of this disease by the score of WELLS. 
• Signs in favor of a pulmonary embolism such as dyspnea, chest pain, desaturation, tachycardia, and the estimation of the clinical probability of this pathology by the SIMPLIFIED GENEVA score.

II.3.3 Variables para cliniques : Tous les patients inclus ont bénéficié d'un écho-Doppler veineux des membres inférieurs à la recherche d'une thrombose veineuse profonde et d'un angioscanner thoracique à la recherche d'une embolie pulmonaire.

II.3.4 Therapeutic variables

The therapeutic management was done by different types of anticoagulants at a curative dose. The choice of molecules was made based on the severity of the disease and the patients' comorbidities.

II.3.4.1 Low molecular weight heparin (LOVENOX 60mg/0.6ml) at a dose of 100IU/kg/12h.

II.3.4.2 Anti vitamin K with a target INR between 2 and 3:

II.3.4.2.1 Acenocoumarol (Sintrom 4mg): Start with 1 cp/jr (3/4 for lean subjects), then adjust doses until the target INR is reached. Time of action 48 to 72 hours. 

II.3.4.2.2 Fluidione (Previscan 20 mg): Start with 1 pc/day. Onset of action 36 to 72 hours.

II.3 4.2.3 Warfarin (Coumadin 5 mg): Start at 5 mg/day. Duration of action 36 to 72 hours.

II.3.4.3 Direct Oral Anticoagulants (DOAC): Their monitoring does not require INR control.

II.3.4.3.1 Rivaroxaban 15 and 20 mg: Start with 15 mg x 2/day for 3 weeks then at 20 mg/day.

II.3.4.3.2Apixaban 5 and 10 mg: start with 10 mg x 2/day for 7 then 5 mg x 2/day. 

II.3.4.4 Fibrinolytics

Streptokinase

II.4 Echantillonnage

We have made an exhaustive recruitment of all hospitalized patients for 

MTEV in the Cardiology service during the study period.

II.5 Management, data analysis, and ethical consideration

Patient participation was obtained after their consent. Anonymity was guaranteed and maintained. The analysis and data processing were carried out using EPI info software version 7.2.3 and Microsoft 365 for data entry, table and figure design. The references were generated by Zotero.

During the study period, 217 patients were hospitalized in the cardiology department, including 31 cases of MVTE, a prevalence of 14.29%. It was 11 men and 20 women, a sex ratio of 0.64. The average age of our patients was 52.31 years 18.84, with extremes of 20 and 80 years. The most affected age group was that of 40-45 years old, which involved 14 patients, or 45, 16%. (Table I)

Table I: Presentation of patients according to epidemiological data

Risk factors for MVTE were dominated by oral contraception (16.12%), followed by prolonged bed rest. (table II).

Table II: Presentation of patients according to risk factors.

The symptomatology of pulmonary embolism was dominated by dyspnea and chest pain at fair proportions (70.96%), while that of DVT was dominated by unilateral painful swelling (29%). (Table III)

Table I: Presentation of patients according to symptoms.

Isolated pulmonary embolism was found in 3 patients (9.68%), DVT in 7 patients (22.58%) and the association of the two [2] pathologies in 21 patients (67.74%). Bilateral proximal pulmonary embolism was found in 54.54% of patients. DVT was more localized at the level of the vein, such as (50%). (Table IV)

Table IV:  Presentation of patients according to the results of the venous Doppler echo of the lower limbs and the thoracic angioscanner.

Therapeutically, among the 21 cases of pulmonary embolism, 3 patients underwent thrombolysis and the other 18 were treated with oral anticoagulation. VKAs were the most used (45.16%). (Table V) The evolution was favorable in 90% of cases. (table VI)

Table V: Presentation of patients according to the treatment received.

Table VI: Presentation of patients according to short-term evolution.

In this work, we encountered difficulties related to the performance of certain paraclinical examinations, notably the thoracic angioscanner, because it is done at a high cost while the population is poor, mostly without insurance.

Nevertheless, this work allows us to have statistics on this health phenomenon and informs us about the use of anti-thrombotics in the treatment of pulmonary embolism.

Our study shows a hospital prevalence of  VTE at the Ignace Deen National Hospital at 14, 29%. This figure is much higher than several data from the literature whose prevalence varies between 1.1 to 3% [1,4,6,7]. This variability in the prevalences of the VTE could result from the difference in the populations studied. These differences may be related to socio-demographic, dietary or genetic factors. They could also be linked to methodological differences used for diagnosis. The means of exploration differ from one region to another, due to a defect in the technical platform and limited access to care.

This high prevalence, in our context, would be justified by the lack of preventive measures for MVTE, particularly in post-surgery.

The female predominance (64.5%) observed in our study corroborates that described in the literature and would probably be related to the existence of factors specific to female sex such as contraception, pregnancy, and postpartum [1,6,7]. On the other hand, in the work of Baye et al. in Senegal, it is men who predominated with a sex ratio of 1.45 in favor of men [7].

We found in our series an average age of 52.31 years 18.84. This result is close to those of Owono in Cameroon and Diallo whose average age of the patients studied is 50.61 years 25 and 52.7 years 14 respectively [6.8]. On the other hand, this data is higher than that found by Diallo et al. In Mali, with an average age of 43 years 9 [11]. 

Oral contraception (16.12%) and prolonged bed rest (6.45%) are the most common risk factors for MVTE in our observation. However, no risk factors were found in a large proportion of the cohort (61.29%). In the study conducted by Rachi et al., The most common risk factors were prolonged immobilisation (24%) and recent surgery (10%); in this observation, etiologies were dominated by neoplasms (26%) [10]. On this issue of MVTE risk factors, there are ...

Clinically, no clinical sign is sensitive and specific enough to confirm or deny VTE. These clinical signs are integrated into scores (Wells or Geneva scores for the EP, Wells score for the DVT) which allow to estimate a priori clinical probability [13]. This clinical probability will allow to guide the realization of complementary examinations and to discuss the urgent introduction of a thrombotic treatment. Despite chest pain and dyspnea are major signs leading to the search for a pulmonary embolism, but they are also found in most cardio-respiratory pathologies [13].  These signs were found in high and fair proportions in our study, 70.96% respectively for chest pain and dyspnea.

In this work, the clinical scores combined with imaging allowed us to diagnose 3 cases of isolated pulmonary embolism (9.68%), 7 cases of isolated DVT (22.58%) and 21 cases of association of these two [2] pathologies (67.74%).  These results are comparable to those of Bell WR et al. who, in a study conducted in the United States, had found 48% isolated TVP and 23% EP with or without TVP [14].

Therapeutically, the management of pulmonary embolism is generally in a hospital setting, while DVT can be treated as an outpatient. Anticoagulant treatment is done parenterally (heparin, thrombotic) and orally (AVK and AOD ,16). The risk of thromboembolic recurrence is low when the initial episode is caused by a major reversible risk factor; in this case, a short treatment of three months is sufficient [17]. In patients who have developed an idiopathic pulmonary embolism (no apparent risk factor) or in association with a persistent risk factor, such as cancer, the risk of recurrence is high; prolonged treatment for at least six months is then necessary [16]. Following this initial analysis, the duration of treatment is then modulated by the presence or absence of certain additional factors (presence of major thrombophilia, persistence of pulmonary arterial hypertension or severity of the episode) [5,18,19]. In our work, all patients were hospitalized, 3 patients benefited from thrombolysis and the other 18 were treated with oral anticoagulation. VKAs were the most used (45.16%).

The evolution was favorable in 90% of the cases of our series, this result is close to that obtained by Maiga and her colleagues in Mali who noted a favorable evolution of VTE under treatment in 84% of the cases [20]. Indeed, the evolution of VTE is good if the management is early and diligent, even before the paraclinical confirmation with a good therapeutic observation

Thromboembolic venous disease is a frequent and fatal pathology. The diagnosis is made by an algorithm where the clinical arguments are grouped on scores and completed by biology or imaging. The treatment of the pathology is done by curative dose anticoagulants for a minimum duration of 3 months. The causes being multifactorial, the availability of more efficient biological laboratories would be of great diagnostic use.

the authors declare no conflict of interest.