Predictive factors for concurrent deep-vein thrombosis and symptomatic venous thromboembolic recurrence in case of superficial venous thrombosis

Abstract

Superficial venous thrombosis (SVT) prognosis is debated and its management is highly variable. It was the objective of this study to assess predictive risk factors for concurrent deep-vein thrombosis (DVT) at presentation and for three-month adverse outcome. Using data from the prospective multicentre OPTIMEV study, we analysed SVT predictive factors associated with concurrent DVT and three-month adverse outcome. Out of 788 SVT included, 227 (28.8%) exhibited a concurrent DVT at presentation. Age >75years (odds ratio [OR]=2.9 [1.5-5.9]), active cancer (OR=2.6 [1.3-5.2]), inpatient status (OR=2.3 [1.2-4.4]) and SVT on non-varicose veins (OR=1.8 [1.1-2.7]) were significantly and independently associated with an increased risk of concurrent DVT. 39.4% of SVT on non-varicose veins presented a concurrent DVT. However, varicose vein status did not influence the three-month prognosis as rates of death, symptomatic venous thromboembolic (VTE) recurrence and major bleeding were equivalent in both non-varicose and varicose SVTs (1.4% vs. 1.1%; 3.4% vs. 2.8%; 0.7% vs. 0.3%). Only male gender (OR=3.5 [1.1-11.3]) and inpatient status (OR=4.5 [1.3-15.3]) were independent predictive factors for symptomatic VTE recurrence but the number of events was low (n=15, 3.0%). Three-month numbers of deaths (n=6, 1.2%) and of major bleedings (n=2, 0.4%) were even lower, precluding any relevant interpretation. In conclusion, SVT on non-varicose veins and some classical risk factors for DVT were predictive factors for concurrent DVT at presentation. As SVT remains mostly a clinical diagnosis, these data may help selecting patients deserving an ultrasound examination or needing anticoagulation while waiting for diagnostic tests. Larger studies are needed to evaluate predictive factors for adverse outcome.

Superficial vein thrombosis and recurrent venous thromboembolism: a pooled analysis of two observational studies

“…The 42 symptomatic VTE events reported allowed us to study the four potential risk factors that we introduced in our multivariate model without overfitting. We were able to confirm, as found in the OPTIMEV exploratory analysis (n = 15 VTE events) and in studies of other presentations of VTE disease, that male sex significantly and independently increased the risk of VTE recurrence at 3 months [11,13]. Some classic risk factors for VTE recurrence in cases of DVT/PE were not found in our multivariate analysis, notably cancer and a personal history of VTE [12].…”

“…First, preliminary analyses were conducted to confirm the appropriate transfer of data. In all cases, we were able to reproduce the results published in both reports [10,11]. Data were then combined into a single database.…”

“…Despite the large number of isolated SVT patients (n = 634) in the POST study (the first multicenter observational study specifically dedicated to SVT), only a few adverse symptomatic events (DVT, PE, and new SVT) were reported at 3 months, which precluded any analyses [10]. A similar study, OPTIMEV, aimed to determine the risk factors and outcomes of different presentations of VTE disease, and included 556 patients with symptomatic objectively confirmed isolated SVT [11].…”

The risk of subsequent cancer and arterial cardiovascular events in patients with superficial vein thrombosis in the legs

“…These conditions share common risk factors 13 and are frequently concomitant. 14,15 In addition, the natural history of isolated SVT in the legs, in analogy with that of DVT, is characterized by an unexpectedly high incidence of symptomatic VTE complications and extension or recurrence of the vascular disorder, 7,15 so that proper anticoagulation with either low molecular weight heparin or fondaparinux is required for at least 4 weeks. 7,16 Although it also would be interesting to know whether SVT places patients at an increased risk of subsequent malignancies, arterial cardiovascular events, or both, this information is unknown.…”

“…Because this may occur in up to 30% of patients with SVT, 14,15 we cannot exclude that the reported risk of cancer was because of the coexistence of DVT. Our results are consistent with those of a recent enquiry conducted in The Netherlands, 6 and suggest that in patients with isolated SVT in the legs-unlike those with DVTneither the risk of subsequent manifest cancer nor that of subsequent arterial cardiovascular events exceeds that expected in the general population.…”