Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep-vein thrombosis.
J Thromb Haemost. 2014 Jan 22;
Authors: Galanaud JP, Sevestre MA, Genty C, Kahn SR, Pernod G, Rolland C, Diard A, Dupas S, Jurus C, Diamand JM, Quere I, Bosson JL, The OPTIMEV-SFMV investigators
BACKGROUND: Isolated distal deep-vein thrombosis (iDDVT) (i.e. without proximal DVT or pulmonary embolism (PE)) represents half of all lower limb DVT. Its clinical significance and management are controversial. Data on long-term follow-up are scarce, especially concerning risk and predictors of venous thromboembolism (VTE) recurrence.
METHODS: Using data from the OPTIMEV study, a prospective, observational, multicentre study, we compared, three years after an index VTE event and after discontinuation of anticoagulants, i) the incidence and type of recurrence in patients without cancer with a first iDDVT vs. a first isolated proximal deep-vein thrombosis (iPDVT); ii) predictors of recurrence after iDDVT.
RESULTS: As compared with patients with iPDVT (n=259), patients with an iDDVT (n=490) had a lower annualized incidence of overall VTE recurrence (5.2% [3.6-7.6] vs. 2.7% (95% CI) [1.9-3.8]) respectively, p=0.02) but a similar incidence of PE recurrence (1.0% [0.5-2.3] vs. 0.9% [0.5-1.6] respectively, p=0.83). An Age>50 years, unprovoked character of index iDDVT, and involvement of more than one vein in one or both legs each independently tripled the risk of recurrence, this latter being then ≥3% per patient-year. Neither muscular vein nor deep-calf vein location of iDDVT nor clot diameter with compression influenced the risk of recurrence.
CONCLUSION: After stopping anticoagulants, patients with iDDVT have a significantly lower risk of overall VTE recurrence than patients with iPDVT, but a similar risk of serious recurrent VTE. Age>50, unprovoked iDDVT, and number of thrombosed veins (>1) influenced the risk of recurrence and may help to define patients at significant risk of recurrence. This article is protected by copyright. All rights reserved.
PMID: 24450376 [PubMed - as supplied by publisher]