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ARTICLE

Residual Venous Thrombosis as a Predictive Factor of Recurrent Venous Thromboembolism

Paolo Prandoni, MD, PhD; Anthonie W.A. Lensing, MD, PhD; Martin H. Prins, MD, PhD; Enrico Bernardi, MD; Antonio Marchiori, MD; Paola Bagatella, MD; Michela Frulla, MD; Laura Mosena, MD; Daniela Tormene, MD; Andrea Piccioli, MD; Paolo Simioni, MD, PhD; and Antonio Girolami, MD

17 December 2002 | Volume 137 Issue 12 | Pages 955-960

Background: The optimum duration of anticoagulant therapy after an episode of deep venous thrombosis (DVT) is controversial. Contributing to the controversy is uncertainty about whether residual venous thrombosis, as assessed by repeated ultrasonography over time, increases the risk for recurrent thromboembolism.

Objective: To determine the risk for recurrent thromboembolism in patients who have persistent residual thrombosis compared with patients who have early vein recanalization.

Design: Prospective cohort study.

Setting: A university hospital in Padua, Italy.

Patients: 313 consecutive symptomatic outpatients with proximal DVT who received conventional short-term anticoagulation.

Measurements: Ultrasonographic assessment of the common femoral and popliteal veins was performed 3 months after acute DVT in all patients and at 6, 12, 24, and 36 months in patients found to have residual venous thrombosis. Veins were considered recanalized if they were 2.0 mm or less in diameter on a single test or 3.0 mm or less in diameter on two consecutive tests. Recurrent thromboembolism was assessed during a 6-year period.

Results: The cumulative incidence of normal results on ultrasonography was 38.8% at 6 months, 58.1% at 12 months, 69.3% at 24 months, and 73.8% at 36 months. Of 58 recurrent episodes, 41 occurred while the patient had residual thrombosis. The hazard ratio for recurrent thromboembolism was 2.4 (95% CI, 1.3 to 4.4; P = 0.004) for patients with persistent residual thrombosis versus those with early vein recanalization.

Conclusions: Residual venous thrombosis is an important risk factor for recurrent thromboembolism. Ultrasonographic assessment of residual venous thrombosis may help clinicians modify the duration of anticoagulation in patients with DVT.

Editors' Notes Context Doctors typically treat deep venous thrombosis with anticoagulants for 3 to 6 months to prevent recurrence. Patients at high risk for recurrence may benefit from longer treatment. Can we identify them with ultrasonography that detects persistent thrombosis? Contribution Three hundred thirteen patients with deep venous thrombosis had ultrasonography every 6 to 12 months for 3 years. Recurrent thromboembolism, assessed over 6 years, was more frequent among those showing persistent residual thrombosis rather than early vein recanalization. Implications We now need trials that evaluate prolonged anticoagulation in patients with and without residual thrombosis to see whether tailoring treatment on the basis of serial ultrasonography is beneficial. –The Editors

 

Author and Article Information

From University Hospital of Padua, Padua, Italy; and University of Amsterdam, Amsterdam, and Maastricht University, Maastricht, the Netherlands.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Paolo Prandoni, MD, PhD, Department of Medical and Surgical Sciences, University of Padua, Via Ospedale Civile 105, 35128 Padua, Italy; e-mail, paoprand{at}tin.it.

Current Author Addresses: Drs. Prandoni, Bernardi, Marchiori, Bagatella, Frulla, Mosena, Tormene, Piccioli, Simioni, and Girolami: Department of Medical and Surgical Sciences, University of Padua, Via Ospedale Civile 105, 35128 Padua, Italy.

Dr. Lensing: Center for Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Box 22660, Amsterdam, the Netherlands.

Dr. Prins: Department of Epidemiology, Maastricht University, PO Box 5800, Maastricht, the Netherlands.

Author Contributions: Conception and design: P. Prandoni, A.W.A. Lensing.

Analysis and interpretation of the data: A.W.A. Lensing, M.H. Prins, E. Bernardi, A. Marchiori, P. Simioni.

Drafting of the article: P. Prandoni, A.W.A. Lensing, E. Bernardi, A. Marchiori, M. Frulla.

Critical revision of the article for important intellectual content: M.H. Prins, M. Frulla, D. Tormene, A. Piccioli, P. Simioni, A. Girolami.

Final approval of the article: P. Prandoni, A.W.A. Lensing, M.H. Prins, E. Bernardi, A. Marchiori, P. Bagatella, M. Frulla, L. Mosena, D. Tormene, A. Piccioli, P. Simioni, A. Girolami.

Provision of study materials or patients: P. Prandoni, P. Bagatella, M. Frulla, L. Mosena, D. Tormene, P. Simioni, A. Girolami.

Statistical expertise: A.W.A. Lensing, M.H. Prins, E. Bernardi, A. Marchiori.

Administrative, technical, or logistic support: D. Tormene, P. Simioni, A. Girolami.

Collection and assembly of data: P. Prandoni, P. Bagatella, L. Mosena, D. Tormene, A. Piccioli, P. Simioni.

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