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

Luca Valerio1, Chiara Ambaglio2, Marisa Barone3

  • 1Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University-Mainz, Mainz, Germany.

TH Open : Companion Journal to Thrombosis and Haemostasis
|June 29, 2019
PubMed

Insights

The location of deep vein thrombosis (DVT) matters for recurrence risk. Distal DVT is favorable without risk factors, but less so with them, especially cancer.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Thrombosis Research

Background:

  • The prognostic significance of distal deep vein thrombosis (DVT) location versus proximal DVT in relation to recurrence risk remains debated.
  • It is unclear if distal DVT is an independent predictor of lower recurrence or a marker for underlying provoking factors of venous thromboembolism (VTE).

Purpose of the Study:

  • To investigate the impact of distal DVT location on the risk of symptomatic, objectively confirmed recurrent VTE.
  • To stratify patients based on the presence of transient or persistent risk factors for VTE.

Main Methods:

  • A cohort of 831 patients with a first acute symptomatic DVT (without pulmonary embolism) was analyzed.
  • Patients were stratified according to risk factors: transient, minor persistent, unprovoked, or cancer-associated.
  • The primary outcome was symptomatic, objectively diagnosed recurrent VTE (including proximal DVT and pulmonary embolism).

Main Results:

  • Overall, 15.0% of patients experienced recurrent DVT or PE.
  • The strongest association between distal DVT and lower recurrence risk was observed in patients without identifiable risk factors (aHR: 0.11).
  • In cancer patients, DVT location (distal vs. proximal) showed a comparable risk of recurrence (aHR: 0.70).

Conclusions:

  • Distal DVT location is a favorable prognostic factor for recurrence in the absence of identifiable transient or persistent risk factors.
  • The prognostic impact of DVT location on recurrence risk is diminished when persistent provoking factors, particularly cancer, are present.

Keywords:
epidemiologyprognosispulmonary embolismvenous thromboembolism

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