Clinical study
Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis?,

https://doi.org/10.1016/S0002-9343(01)00661-1Get rights and content

Abstract

PURPOSE: To determine if the location of deep vein thrombosis is a predictor of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy.

METHODS: The study population consisted of 1,149 consecutive patients with symptomatic proximal deep vein thrombosis. In all patients, deep vein thrombosis was confirmed by Duplex ultrasound or venography and was classified as popliteal, femoral, or iliofemoral. Patients received initial treatment with unfractionated heparin, enoxaparin, or reviparin for least 4 days, as well as a coumarin derivative, with a target international normalized ratio of 2.0 to 3.0, starting on the 1st or 2nd day of treatment. All patients were followed for 3 months, and all episodes of recurrent venous thromboembolism were confirmed with objective diagnostic tests.

RESULTS: The overall rate of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy was 5.5% (63/1,149). The rate of recurrence in patients with popliteal vein thrombosis was 5.1% (23/453); in patients with femoral vein thrombosis, it was 5.3% (34/645); and in patients with iliofemoral vein thrombosis, it was 11.8% (6/51). Two clinical risk factors were associated with an increased risk of recurrent venous thromboembolism: iliofemoral vein thrombosis (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 0.95, 5.9), and cancer (OR = 2.6; 95% CI: 1.5, 4.4).

CONCLUSIONS: Patients with extensive iliofemoral vein thrombosis who receive conventional anticoagulant therapy have a greater than twofold higher risk of developing recurrent venous thromboembolism than patients without iliac vein involvement (i.e., 11.8% vs. 5.2%). Prospective studies are needed to determine whether alternative antithrombotic strategies are warranted in such patients.

Section snippets

Subjects

The study population consisted of 1,149 consecutive patients with symptomatic, lower limb, deep vein thrombosis. In all patients, deep vein thrombosis was confirmed by Duplex ultrasound or venography. Proximal vein thrombosis was classified into one of three categories according to the most proximal vein segment involved. The three categories were popliteal (popliteal vein only), femoral (superficial or common femoral veins), or iliofemoral (iliac and femoral veins). All patients received

Results

Of 1,149 patients with symptomatic proximal deep vein thrombosis, 453 (39.4%) had popliteal vein thrombosis, 645 (56.1%) had femoral vein thrombosis, and 51 (4.4%) had iliofemoral vein thrombosis. The baseline clinical characteristics of the study population are presented in Table 1. The mean age of the study population was 60.3 years (SD = 16.7 years), of whom 633 (55%) were men and 516 (45%) were women. In terms of risk factors for recurrent venous thromboembolism in these 1,149 patients, 239

Discussion

In this analysis of a large patient population with symptomatic proximal vein thrombosis, the location of thrombosis was a predictor of disease recurrence during the initial 3 months of anticoagulant therapy. Patients with iliofemoral vein thrombosis had a greater than twofold higher rate of recurrence than patients with thrombosis that was limited to the femoral or popliteal veins (i.e., 11.8% vs. 5.2%). Although this difference did not reach conventional statistical significance in the

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Dr. Douketis is the recipient of a research scholarship from the Heart and Stroke Foundation of Ontario, Dr. Crowther is the recipient of a research scholarship from the Canadian Institutes of Health Research, and Dr. Ginsberg is the recipient of a Career Investigator Award from the Heart and Stroke Foundation of Ontario.

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