Jain Nidhi, Avanthika Chaithanya, Singh Abhishek, Jhaveri Sharan, De la Hoz Ivonne, Hassen Gashaw, Camacho L Genesis P, Carrera Keila G
Medicine and Surgery, Himalayan Institute of Medical Sciences, Dehradun, IND.
Internal Medicine, Sir Ganga Ram Hospital, Delhi, IND.
Cureus. 2021 Oct 3;13(10):e18457. doi: 10.7759/cureus.18457. eCollection 2021 Oct.
The prevalence of intravenous drug use has increased in the past decade and it represents an important risk factor for deep vein thrombosis. Intravenous drug use is a global problem, with the main culprit being heroin. Peer pressure and poverty in high-risk groups such as sex workers, females, and young adults raise the risk of intravenous drug use, which expresses itself in the form of venous thromboembolism eventually. Deep vein thrombosis typically manifests itself eight years after the initial intravenous drug administration, rendering it a silent killer. Aiming to review and summarize existing articles in this context, we performed an exhaustive literature search online on PubMed and Google Scholar indexes using the keywords "Deep Venous Thrombosis (DVT)" and "Intravenous Drug Users (IVDU)." English articles that addressed epidemiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, management, and outcomes of DVT, including those in IVDU, were selected and analyzed. The pathogenesis of DVT development in IVDU is mainly attributed to the interplay of trauma to the vessel by repeated injection and the injected drug itself. The right-sided femoral vein is the most common vein affected. Prevalent clinical presentations include local pain, swelling, and redness with typical systemic symptoms including fever, cough, dyspnea, and chest pain on top of addiction features. There appeared to be a delay in reporting symptoms, which was most likely due to the social stigma attached to IVDU. There are over 50 conditions that present with swollen and painful limbs comparable to DVT in IVDU, making precise diagnosis critical for timely treatment. Venous ultrasound is the method of choice for diagnosing DVT. Extended anticoagulant therapy with low-molecular-weight heparin combined with warfarin is the recommended treatment. Intravenous drug abusers having DVT are affected by multiple complications and poorer outcomes such as slower recovery, recurrent venous thromboembolism (VTE), and a longer hospital stay, which put them at higher risk of morbidity, mortality, reduced productivity, and economic burden.
在过去十年中，静脉注射吸毒的流行率有所上升，它是深静脉血栓形成的一个重要危险因素。静脉注射吸毒是一个全球性问题，主要罪魁祸首是海洛因。性工作者、女性和年轻人等高风险群体中的同伴压力和贫困增加了静脉注射吸毒的风险，最终表现为静脉血栓栓塞。深静脉血栓形成通常在首次静脉注射吸毒八年后出现，使其成为一个无声的杀手。为了在这种背景下回顾和总结现有文章，我们在PubMed和谷歌学术索引上进行了详尽的在线文献检索，使用关键词“深静脉血栓形成（DVT）”和“静脉注射吸毒者（IVDU）”。选择并分析了涉及DVT的流行病学、发病机制、临床表现、诊断、鉴别诊断、管理和结果的英文文章，包括IVDU中的相关文章。IVDU中DVT发生的发病机制主要归因于反复注射对血管的创伤与所注射药物本身的相互作用。右侧股静脉是最常受累的静脉。常见的临床表现包括局部疼痛、肿胀和发红，除成瘾特征外，典型的全身症状包括发热、咳嗽、呼吸困难和胸痛。症状报告似乎存在延迟，这很可能是由于与IVDU相关的社会耻辱感。有超过50种情况表现为肢体肿胀和疼痛，与IVDU中的DVT相似，因此精确诊断对于及时治疗至关重要。静脉超声是诊断DVT的首选方法。推荐的治疗方法是低分子量肝素联合华法林进行延长抗凝治疗。患有DVT的静脉注射吸毒者受到多种并发症和较差预后的影响，如恢复较慢、复发性静脉血栓栓塞（VTE）和住院时间延长，这使他们面临更高的发病、死亡、生产力下降和经济负担风险。
