 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
Clots and clogged veins can be detected with ultrasonographic scans. The scans use short pulses of sound waves transmitted from a device placed on the surface of the skin to look at whether blood flow in the veins is decreased from clots. Follow-up scans can identify patients with remaining clots despite treatment. But do these patients have high risks for repeat clots?
SUMMARIES FOR PATIENTS
Risks for Persistent Clots in Leg Veins despite Treatment
17 December 2002 | Volume 137 Issue 12 | Page I-32
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Residual Venous Thrombosis as a Predictive Factor of Recurrent Venous Thromboembolism." It is in the 17 December 2002 issue of Annals of Internal Medicine (volume 137, pages 955-960). The authors are P Prandoni, AWA Lensing, MH Prins, E Bernardi, A Marchiori, P Bagatella, M Frulla, L Mosena, D Tormene, A Piccioli, P Simioni, and A Girolami.
What is the problem and what is known about it so far?
Sometimes adults get blood clots in their veins, a condition known as deep venous thrombosis (DVT). The blood clots usually form in leg veins. Blood clots in the deep veins of the legs are dangerous because they can break free and travel to the lungs. This problem, called pulmonary embolism (clot in the lung), can be fatal. Doctors typically treat patients with DVT with blood-thinning drugs for 3 to 6 months. The blood-thinning drugs help dissolve clots, reduce the risk that a clot will travel to the lungs, and prevent repeat clots. Some patients may have high risks for repeat clots and may benefit from longer treatment.
Why did the researchers do this particular study?
To see whether patients with DVT who have remaining clots in the leg vein after 3 months of treatment have higher risks for repeat clots than patients whose veins are unclogged with treatment.
Who was studied?
313 adults with a single episode of DVT who had been treated with blood-thinning drugs for 3 months.
How was the study done?
The researchers told the patients to stop taking blood thinners. The researchers then scanned the leg with the original DVT using ultrasonography. Patients with evidence of persistent vein clogging had repeat scans every 6 to 12 months for 3 years. All patients were followed for 6 years. They routinely reported any symptoms or signs of new clots. Researchers verified possible new clots in either the legs or lungs with scans or special x-rays taken after injecting dye into the veins (venography). Researchers then looked at the frequency of repeat clots among people who had and had not shown persistent vein clogging after the original DVT.
What did the researchers find?
Rates of scans with no evidence of persistent clots were about 40% at 6 months, 60% at 1 year, 70% at 2 years, and 75% at 3 years. Fifty-eight people had repeat clots in the legs or lungs during the 6-year follow-up period. Most repeat clots (71%) occurred in people who had had evidence of persistent clots on scans.
What were the limitations of the study?
Although patients were told to stop taking blood thinners 3 months after their first DVT, about 20% continued taking blood thinners for another 3 to 6 months. Rates of persistently abnormal results on ultrasonography and repeat clots were probably lower than what would have been seen if all patients had stopped blood thinners at 3 months.
What are the implications of the study?
Patients who have persistent clots despite 3 months of treatment for a first episode of DVT have increased risks for repeat episodes of clots in the legs or lungs. We now need studies to see whether it is beneficial to tailor treatment based on findings of persistent clots.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  M. Verhovsek, J. D. Douketis, Q. Yi, S. Shrivastava, R. C. Tait, T. Baglin, D. Poli, and W. Lim Systematic Review: D-Dimer to Predict Recurrent Disease after Stopping Anticoagulant Therapy for Unprovoked Venous Thromboembolism Ann Intern Med, October 7, 2008; 149(7): 481 - 490. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Altinisik, O. Ates, T. Ulutin, M. Cengiz, and N. Buyru Factor V Leiden, Prothrombin G20210A, and Protein C Mutation Frequency in Turkish Venous Thrombosis Patients Clinical and Applied Thrombosis/Hemostasis, October 1, 2008; 14(4): 415 - 420. [Abstract] [PDF]
|
|
|
|
 |
|
 M. A. Rodger MD MSc, S. R. Kahn MD MSc, P. S. Wells MD MSc, D. A. Anderson MD, I. Chagnon MD, G. Le Gal MD PhD, S. Solymoss MD, M. Crowther MD, A. Perrier MD, R. White MD, et al. Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy Can. Med. Assoc. J., August 26, 2008; 179(5): 417 - 426. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Siragusa, A. Malato, R. Anastasio, V. Cigna, G. Milio, C. Amato, M. Bellisi, M. T. Attanzio, O. Cormaci, M. Pellegrino, et al. Residual vein thrombosis to establish duration of anticoagulation after a first episode of deep vein thrombosis: the Duration of Anticoagulation based on Compression UltraSonography (DACUS) study Blood, August 1, 2008; 112(3): 511 - 515. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Kearon, S. R. Kahn, G. Agnelli, S. Goldhaber, G. E. Raskob, and A. J. Comerota Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 454S - 545S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Vedantham Superficial venous interventions: assessing the risk of DVT Phlebology, April 1, 2008; 23(2): 53 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Heit The Epidemiology of Venous Thromboembolism in the Community Arterioscler. Thromb. Vasc. Biol., March 1, 2008; 28(3): 370 - 372. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Brighton, J. Janssen, and S. P. Butler Aging of Acute Deep Vein Thrombosis Measured by Radiolabeled 99mTc-rt-PA J. Nucl. Med., June 1, 2007; 48(6): 873 - 878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Scarvelis and P. S. Wells Diagnosis and treatment of deep-vein thrombosis. Can. Med. Assoc. J., October 24, 2006; 175(9): 1087 - 1092. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Henke, C. G. Pearce, D. M. Moaveni, A. J. Moore, E. M. Lynch, C. Longo, M. Varma, N. A. Dewyer, K. B. Deatrick, G. R. Upchurch Jr, et al. Targeted Deletion of CCR2 Impairs Deep Vein Thombosis Resolution in a Mouse Model. J. Immunol., September 1, 2006; 177(5): 3388 - 3397. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. de Moerloose, C. M. Samama, and S. Motte Management of venous thromboembolism: [Traitement de la maladie thromboembolique veineuse]. Can J Anesth, June 1, 2006; 53(6_suppl): S80 - S88. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nijkeuter, M. M.C. Hovens, B. L. Davidson, and M. V. Huisman Resolution of Thromboemboli in Patients With Acute Pulmonary Embolism: A Systematic Review Chest, January 1, 2006; 129(1): 192 - 197. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. L. Bockenstedt Management of Hereditary Hypercoagulable Disorders Hematology, January 1, 2006; 2006(1): 444 - 449. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. A. Goldenberg, R. Knapp-Clevenger, T. Hays, and M. J. Manco-Johnson Lemierre's and Lemierre's-Like Syndromes in Children: Survival and Thromboembolic Outcomes Pediatrics, October 1, 2005; 116(4): e543 - e548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Girard, O. Sanchez, C. Leroyer, D. Musset, G. Meyer, J.-B. Stern, F. Parent, and for the Evaluation du Scanner Spirale dans l'Embol Deep Venous Thrombosis in Patients With Acute Pulmonary Embolism: Prevalence, Risk Factors, and Clinical Significance Chest, September 1, 2005; 128(3): 1593 - 1600. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Christiansen, S. C. Cannegieter, T. Koster, J. P. Vandenbroucke, and F. R. Rosendaal Thrombophilia, Clinical Factors, and Recurrent Venous Thrombotic Events JAMA, May 18, 2005; 293(19): 2352 - 2361. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Z. Goldhaber Prevention of Recurrent Idiopathic Venous Thromboembolism Circulation, December 14, 2004; 110(24_suppl_1): IV-20 - IV-24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. W. Rathbun, T. L. Whitsett, and G. E. Raskob Negative D-dimer Result To Exclude Recurrent Deep Venous Thrombosis: A Management Trial Ann Intern Med, December 7, 2004; 141(11): 839 - 845. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Buller, G. Agnelli, R. D. Hull, T. M. Hyers, M. H. Prins, and G. E. Raskob Antithrombotic Therapy for Venous Thromboembolic Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 401S - 428S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon Long-Term Management of Patients After Venous Thromboembolism Circulation, August 31, 2004; 110(9_suppl_1): I-10 - I-18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. S. Elting, C. P. Escalante, C. Cooksley, E. B. C. Avritscher, D. Kurtin, L. Hamblin, S. G. Khosla, and E. Rivera Outcomes and Cost of Deep Venous Thrombosis Among Patients With Cancer Arch Intern Med, August 9, 2004; 164(15): 1653 - 1661. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Prandoni Ximelagatran reduced venous thromboembolism more than warfarin after total knee replacement Evid. Based Med., July 1, 2004; 9(4): 106 - 106. [Full Text] [PDF]
|
|
|
|
|
|
P. Prandoni Ximelagatran prevented secondary venous thromboembolism Evid. Based Med., July 1, 2004; 9(4): 107 - 107. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Caprini, C. J. Glase, C. B. Anderson, and K. Hathaway Laboratory Markers in the Diagnosis of Venous Thromboembolism Circulation, March 30, 2004; 109(12_suppl_1): I-4 - I-8. [Abstract] [Full Text]
|
|
|
|
|
|
J. I. Weitz, S. Middeldorp, W. Geerts, and J. A. Heit Thrombophilia and New Anticoagulant Drugs Hematology, January 1, 2004; 2004(1): 424 - 438. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Lopez, C. Kearon, and A. Y.Y. Lee Deep Venous Thrombosis Hematology, January 1, 2004; 2004(1): 439 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Sebastian and D. M. Torre Residual Venous Thrombosis and Recurrent Thromboembolism Ann Intern Med, August 19, 2003; 139(4): 303 - 303. [Full Text] [PDF]
|
|
|
|
|
|
J. Emmerich and J.-N. Fiessinger Residual Venous Thrombosis and Recurrent Thromboembolism Ann Intern Med, August 19, 2003; 139(4): 303 - 303. [Full Text] [PDF]
|
|
|
|
|
|
V. Rajput Residual Venous Thrombosis and Recurrent Thromboembolism Ann Intern Med, August 19, 2003; 139(4): 303 - 304. [Full Text] [PDF]
|
|
|
|
 |
|
 R Zannolli, M A Mazzei, P Sacco, V Turchetti, T Amato, S Battistini, R Berardi, L Volterrani, V De Stefano, G Morgese, et al. Posterior knee pain: primary symptom of a small non-occlusive venous clot Arch. Dis. Child., August 1, 2003; 88(8): 728 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon Natural History of Venous Thromboembolism Circulation, June 17, 2003; 107(90231): I-22 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Residual Thrombosis: A Risk Factor for Recurrent DVT Journal Watch (General), January 24, 2003; 2003(124): 1 - 1. [Full Text]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
