**4. Conclusion**

In conclusion, we believe that addressing DVT as a regional public health problem in the developing countries should take a multi-dimensional approach targeting the epidemiology of DVT and implementation of cost-effective preventive and therapeutic programs.

### **5. References**

106 Deep Vein Thrombosis

We believe that intensive awareness and educational campaigns supported by the media and endorsed by the governments will contribute in limiting the DVT problem. For example, school teachers and cashiers should be advised, and allowed, to move around during their working hours since their job entails long standing hours. Educational initiatives in the airports and airplanes in the form of brochures or brief videos are encouraged to increase travelers' awareness. With such efforts, it might be expected that there would be a reduction in the number of individuals who develop DVT which, in turn, might reduce the number of patients requiring treatment and follow up as post thrombotic

The use of pretest probability scoring system such as Geneva score (Kelly et al., 2003), Wells score (Wells et al., 1997) to diagnosis DVT is considered commendable efforts towards early diagnosis. This could be germane to the developing countries in reducing the economic cost that may have the impact on the scale of DVT. This will also help the researchers and clinicians, policymakers to make proper assessment of the magnitude of the problem,

We believe that the lack of training programs in clinical hematology in the developing countries is contributing to the problem of misdiagnosing and under-diagnosing of DVT. Unlike the Western countries, such training programs are limited to the medical schools which may not meet the need of any country to well-trained hematologists. It is important that special emphasis on undergraduate medical education, by inclusion of management and prevention strategies in the medical curriculum, will increase the early reporting of DVT by different medical specialists. On the other hand, training programs should be developed to train the allied health professionals (e.g. nurses, technicians etc…) on aiding the clinicians in diagnosing DVT. Establishing a strong research infrastructure in terms of highly trained and qualified fulltime research personnel, research facilities and budgets will help to bridge the

There are some cultural and social issues that may contribute to the underreporting of the DVT in the developing countries. Having a chronic disease may represent a stigma. Being diagnosed with DVT is considered a social disability. Women usually hide having any kind of disease especially if it is DVT-related pregnancy which may affect her ability of

In conclusion, we believe that addressing DVT as a regional public health problem in the developing countries should take a multi-dimensional approach targeting the epidemiology

of DVT and implementation of cost-effective preventive and therapeutic programs.

**3.2.5 Awareness and education of the public** 

syndrome long run.

**3.2.6 DVT diagnosis** 

management, and prevention strategies.

**3.2.7 Clinical and research training programs** 

knowledge gaps in DVT in developing countries.

**3.2.8 Cultural and social issues** 

childbearing.

**4. Conclusion** 


Emerging Issues in Deep Vein Thrombosis; (DVT) in Liver Disease and in Developing Countries 109

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**1. Introduction** 

**7** 

 *Jordan* 

**Venous Thromboembolism** 

Hikmat Abdel-Razeq

*King Hussein Cancer Center, Amman,* 

 **Prophylaxis in Cancer Patients** 

Venous Thromboembolism (VTE) is a common disease, comprising the life-threatening pulmonary embolism (PE) and its precursor deep vein thrombosis (DVT). In view of the clinically silent nature of VTE; the incidence, prevalence and mortality rates are probably under estimated (Kniffin et al., 1994). Although VTE is a common disease, fortunately it is preventable; identifying high risk patients and the application of suitable prophylactic measures is the best way to decrease the incidence of VTE and its associated complications. Using unfractionated heparin (UFH), the rate of radiologically detected DVT was reduced

Although most patients survive DVT, they often suffer serious and costly long-term complications. Venous stasis syndrome (postphlebitic syndrome) with painful swelling and recurrent ulcers is well known complication following DVT (Prandoni et al., 1996). Additionally, PE is associated with substantial morbidity and mortality both tend to be higher among cancer patients and those who survive such event may develop chronic complications like pulmonary hypertension (Carson et al., 1992; Pengo et al., 2004). In a large study, Sørensen et al. examined the survival of patients with cancer and VTE compared to those without VTE matched for many factors including the type and duration of cancer diagnosis; the one year survival rate for cancer patients with VTE was 12% compared to 36% in the control group (P<0.001). Furthermore, the risk of VTE recurrence

The association between cancer and thrombosis is well-established since the first observation made by Armand Trousseau more than hundred years ago (Prandoni et al., 1992). Cancer and its treatment are recognized risk factors for VTE; in a population-based case-control study of 625 Olmsted County patients, the risk of VTE was six- fold higher in cancer patients compared to those without (Heit et al., 2000). Thrombosis is the most frequent complication and the second cause of death in patients with overt malignant diseases. Increasing evidence suggests that thrombotic episodes may also precede the diagnosis of cancer by months or years (Donati, 1995). The risk of VTE varies by cancer type; higher in patients with malignant brain tumors and adenocarcinoma of the pancreas, colon,

by 67% without significant bleeding complications (Belch et al., 1981).

was higher in cancer patients compared to those without (Sørensen et al., 2000).

**2. Cancer as a risk factor for VTE** 

