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. 2019 Mar 11;3(1):e58-e63.
doi: 10.1055/s-0039-1683374. eCollection 2019 Jan.

Recurrence Risk after First Symptomatic Distal versus Proximal Deep Vein Thrombosis According to Baseline Risk Factors

Luca Valerio  1 , Chiara Ambaglio  2 , Marisa Barone  3 , Mariella Ciola  2 , Stavros V Konstantinides  1   4 , Seyed H Mahmoudpour  1   5 , Chiara Picchi  6 , Carla Pieresca  2 , Alice Trinchero  1 , Stefano Barco  1
Affiliations

Recurrence Risk after First Symptomatic Distal versus Proximal Deep Vein Thrombosis According to Baseline Risk Factors

Luca Valerio et al. TH Open. .

Abstract

Background It remains unclear whether the distal location of deep vein thrombosis (DVT) is independently associated with a lower risk of recurrence in all patients, or represents a marker of the presence and severity of provoking factors for venous thromboembolism (VTE). Methods We investigated the impact of distal (vs. proximal) DVT location on the risk of developing symptomatic, objectively confirmed recurrent VTE in 831 patients with a first acute symptomatic DVT not associated with pulmonary embolism (PE), who were stratified by the presence of transient or persistent risk factors at baseline. The primary outcome was symptomatic, objectively diagnosed recurrent VTE, including proximal DVT and PE. Results A total of 205 (24.7%) patients presented with a transient risk factor, 189 (22.7%) with a minor persistent risk factor, 202 (24.3%) with unprovoked DVT, and 235 (28.3%) with cancer-associated DVT. One-hundred twenty-five patients (15.0%) experienced recurrent DVT or PE. The largest relative difference between patients with distal (vs. proximal) DVT was observed in the absence of identifiable risk factors (adjusted hazard ratio [aHR]: 0.11; 95% CI [confidence interval]: 0.03-0.45). In patients with cancer, distal and proximal DVT had a comparable risk of recurrence (aHR: 0.70; 95% CI: 0.28-1.78]). Conclusions The distal (vs. proximal) location of first acute symptomatic DVT represented, in the absence of any identifiable transient or persistent risk factors, a favorable prognostic factor for recurrence. In contrast, the prognostic impact of DVT location was weaker if persistent provoking risk factors for VTE were present, notably cancer.

Keywords: epidemiology; prognosis; pulmonary embolism; venous thromboembolism.

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Conflict of interest statement

Conflicts of Interest S.B. has received payment for travel accommodation from Daiichi Sankyo and Bayer HealthCare and lecture fees from BTG Interventional Medicine. S.V.K. reports having received lecture fees and advisory board honoraria from Bayer Health Care, Boehringer Ingelheim, Pfizer–Bristol-Myers Squibb, Daiichi-Sankyo, and Actelion, and research grants to his institution from Bayer Health Care, Boehringer Ingelheim, and Actelion. The other authors do not report any conflicts of interest.

Figures

Fig. 1
Fig. 1
Prognostic value of distal (vs. proximal) isolated deep vein thrombosis (DVT) according to baseline provoking risk factors. Rates and hazard ratios (HR) for cancer-associated DVT patients off anticoagulants were not calculated as the mortality rate was high and vast majority of them received extended anticoagulant treatment. Adjusted HRs account for age, sex, length of anticoagulant treatment (only for events on and off anticoagulant), in-hospital status at the time of DVT diagnosis. CI, confidence interval; IDDVT, isolated distal deep vein thrombosis.
Fig. 2
Fig. 2
Cumulative rate of recurrent deep vein thrombosis (DVT) or pulmonary embolism in patients with first distal versus proximal DVT stratified according to baseline risk factors.
Fig. 3
Fig. 3
Cumulative mortality after first distal versus proximal cancer-associated deep vein thrombosis (DVT).
See this image and copyright information in PMC

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