Residual Venous Thrombosis as a Predictive Factor of Recurrent Venous Thromboembolism

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

doi:10.7326/0003-4819-137-12-200212170-00008

Cited by 483 publications

(375 citation statements)

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“…It has been previously shown that a considerable number of recurrences can be seen in the opposite leg or present as PE [1,3,5]. Young et al [5] suggested that residual thrombus in DVT may be a marker for a generalized procoagulant diathesis.…”

Section: Discussıonmentioning

confidence: 99%

“…Anticoagulant therapy remains the mainstay of medical therapy for VTE. Patients who have residual venous thrombosis (RVT) after completion of oral anticoagulant therapy have been shown to have higher rates of recurrent VTE [1,2]. RVT has been reported to be an independent risk factor for recurrent thromboembolic event and is generally considered a marker of hypercoagulability.…”

Section: Introductionmentioning

confidence: 99%

“…RVT has been reported to be an independent risk factor for recurrent thromboembolic event and is generally considered a marker of hypercoagulability. Thus, RVT can be used for the risk stratification of patients with DVT and plays a vital role in determining the duration of anticoagulation [1,[3][4][5]. Therefore, it is of high clinical importance to distinguish patients with RVT from those who fully recovered.…”

Section: Introductionmentioning

confidence: 99%

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Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

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et al. 2014

Indian J Hematol Blood Transfus

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We aimed to evaluate whether mean platelet volume (MPV) and platelet distribution width (PDW) are helpful to identify complete thrombus resolution (CTR) after acute deep venous thrombosis (DVT). Patients who had first-time episode of acute proximal DVT were included in this retrospective study. 100 patients with DVT were divided into two groups according to absence (group 1; n = 68) or presence (group 2; n = 32) of CTR on doppler ultrasonography at month 6. There were no significant difference in admission MPV and PDW levels between group 1 and group 2. MPV (p = 0.03) and PDW (p \ 0.001) levels at month 6 were significantly higher in group 1 than in group 2. CTR showed a moderate negative correlation with PDW at month 6 (q = -0.47) and a weak negative correlation with MPV at month 6 (q = -0.26). Logistic regression analysis showed that PDW (OR, 2.2; p = 0.004) at month 6 was an independent risk factor for the presence of residual venous thrombosis in DVT patients. Receiver operating characteristics analysis revealed that a 8.4 % decrease in admission MPV at month 6 provided 62 % sensitivity and 62 % specificity (AUC: 0.64) and a 15.4 % decrease in admission PDW at month 6 provided 87 % sensitivity and 94 % specificity (AUC: 0.89) for prediction of CTR in DVT patients. Percent change in admission MPV and PDW levels at month 6 may be used to identify the patients with CTR after a first episode of acute proximal DVT.

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Section: Discussıonmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

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et al. 2014

Indian J Hematol Blood Transfus

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“…In particular, compression venous ultrasound (CVU), which is the current mainstay of DVT diagnosis, can be problematic, since abnormalities (thickening and increased echogenicity of the vessel wall, resistance to compression) may be detected in up to 70% of patients despite no evidence of recurrent disease in the year following a DVT and even remain as a permanent sequel in an area of previous thrombus [3]. Additionally, recurrent thrombotic episodes have been advocated to be more likely in those cases in which CVU abnormalities persist several months after the initial episode [4].…”

Section: Introductionmentioning

confidence: 99%

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Aguilar¹,

Villar²

2006

American J Hematol

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It is estimated that up to one-third of patients with a history of deep venous thrombosis (DVT) present with symptoms of recurrent DVT. Our objective was to investigate both the diagnostic value of D-dimer (DD) and safety of a standard diagnostic algorithm including clinical assessment, plasma DD levels, and compression venous ultrasound as diagnostic tools in outpatients presenting with clinically suspected acute recurrent DVT of the lower limbs. We have enrolled 105 outpatients with a previous history of confirmed DVT and clinically suspected recurrent DVT. A 3-month follow-up period was carried out for patients in whom DVT was initially excluded. Prevalence of DVT in our study population was 44.8% (47/105). DD was negative in 17.1% of cases (18/105) and DVT could be ruled out in 15.2% of patients evaluated (16/105) on the basis of an unlikely clinical probability and a negative DD result. Only one false negative DD result in a patient scored as likely for DVT was found. Sensitivity, specificity, positive and negative predictive value of DD for the diagnosis of DVT were 97.9% (95% CI 88.9-99.6%), 29.3% (95% CI 19.2-42.0%), 52.9% (95% CI 42.5-63.0) and 94.4% (95% CI 74.2%-99.0), respectively. Sensitivity was 100% (95% CI 75.7-100) in the group of patients in whom DVT was considered unlikely. A diagnostic strategy combining clinical evaluation and DD has proved to be useful for the exclusion of DVT in subjects with clinically suspected recurrent DVT, especially in patients included in the lower clinical pretest probability group. Am. J. Hematol. 82:41-44, 2007. V V C 2006 Wiley-Liss, Inc.

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“…Normalization of vascular studies occurs in 73.8% of individuals by 3 years without significant differences between patients with or without thrombophilic defects. 16 The hazard ratio for recurrent VTE was 2.9 (95% CI 1.6-5.2) for patients with residual thrombosis on Doppler ultrasound.…”

Section: Residual Venous Thrombosismentioning

confidence: 93%

Management of Hereditary Hypercoagulable Disorders

Bockenstedt¹

2006

Hematology

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The clinical management of individuals with hereditary hypercoaguable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism to a more intricate individualized risk-benefit analysis as studies have begun to delineate the complexity of interactions of acquired and hereditary factors which determine the predilection to thrombosis. The contribution of thrombophilic disorders to risk of thrombotic complications of pregnancy, organ transplantation, central venous catheter and dialysis access placement have been increasingly recognized. The risk of thrombosis must be weighed against risk of long-term anticoagulation in patients with venous thromboembolism. Thrombophilia screening in select populations may enhance outcome. Initial DecisionsThe clinical management of individuals with hereditary hypercoagulable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism (VTE) to a more intricate, individualized risk-benefit analysis as the complexity of interactions of acquired and hereditary factors that determine the predilection to thrombosis are now recognized. Important behind stratifying risk of recurrent events is the necessity of correctly identifying hereditary thrombophilic disorders, especially in circumstances in which laboratory results, e.g., mildly low antithrombin III (ATIII) or protein S levels, may be more indicative of a temporary acquired deficiency. The relevance of thrombophilic testing is debated, but most clinicians agree that prothrombotic assessment should be considered in individuals with unprovoked thrombosis at age less than 40 years, individuals who have had thrombosis at an unusual anatomic site or who have had repeated thromboses, or when the family history suggests multiple affected individuals. For review of the laboratory assessment of thrombophilia see references [1][2][3] . The following discussion is not meant to be comprehensive, but serves to highlight a few of the clinical management decisions important in the care of the thrombophilic patient. Therapeutic considerations involving individuals with antiphospholipid syndrome (APS) will be included where pertinent. Duration of anticoagulant therapyThe decision to extend therapy beyond 6-12 months after an incident thrombotic event must be made on an individual basis. Patients with a transient risk factor such as oral contraceptive use, postsurgical state or limb immobilization have a low risk of recurrence of thrombosis once anticoagulation has been completed. (For review see 4,5 .) Identifying the individual with moderate to high risk of recurrent thrombosis is important to prevent the unnecessary risk of hemorrhage from long-term anticoagulation. From studies of patients with a first VTE (both with and without diagnosed hereditary thrombophilia), one third of patients with unprovoked VTE will have a reoccurrence over the next 10 years and 6% of patients with VTE develop postphlebitic syndrom...

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Residual Venous Thrombosis as a Predictive Factor of Recurrent Venous Thromboembolism

Abstract: 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.

Cited by 483 publications

References 31 publications

Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Management of Hereditary Hypercoagulable Disorders

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