Residual venous thrombosis as predictive factor for recurrent venous thromboembolim in patients with proximal deep vein thrombosis: a sytematic review

Abstract

Summary The potential role of the detection of residual thrombosis after deep vein thrombosis (DVT) in the differentiation of patients at risk for recurrent venous thromboembolism (VTE) has not yet been fully established and includes different definitions. We performed a systematic review in order to determine the role of residual thrombosis in predicting recurrent VTE after acute proximal DVT. Databases were searched until June 2010. Randomized, controlled trials or prospective cohort studies were eligible for inclusion if they included patients with objectively diagnosed proximal DVT, measured thrombus diameter after at least 3 months and reported recurrent VTE during follow‐up. Two authors independently reviewed articles and extracted data. Data from 11 studies were used for the current analysis; in total 3203 patients were included. Residual thrombosis was positively correlated with recurrent VTE. Large heterogeneity was present, due to differences in study population, timing and the differences in method of measuring residual thrombosis. The effect was more pronounced in patients with malignancy or was dependent on the criteria used. This systematic review shows a positive relationship between residual thrombosis and recurrent VTE during follow‐up. Assessing residual thrombosis could be useful in individual recurrence risk estimation.

Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

“…Toward this end, we investigated 409 patients with unprovoked DVT, managed entirely accordingly to RVT detection after 3 months of VKA. Detection of RVT at this time may be considered somewhat premature, although our approach reflects previous findings [8,12,19]. In this view, early RVT detection may be an appropriate marker for assessing the minimal length of VKA in low risk patients.…”

“…The association between abnormal CUS at inclusion and risk of recurrent VTE yielded a hazard ratio that was not significant (1.4, 95% CI 5 0.9-2.1) [18]. These data were not confirmed by a recent systematic review showing that residual thrombosis positively correlated with recurrent VTE, although large heterogeneities were present, due to differences in study population, timing, and differences in methods of measuring residual thrombosis [12].…”

“…In addition, no clear indications were given for how long patients with persistent RVT or positive D-dimer should be treated, since a significant risk for recurrent VTE persists even after 1 year of anticoagulation [7][8][9]. In fact, none of these studies has offered clear results regarding assessment of the optimal duration of VKA treatment, even after the analysis of pooled data [11,12].…”

The value of tomographic ventilation/perfusion scintigraphy (V/PSPECT) for follow-up and prediction of recurrence in pulmonary embolism

“…Evaluation of PE resolution both in early and later stages after thrombolysis is another field in which V/P SPECT should be evaluated in a separate prospective setting. When evaluating risk for recurrent deep venous thrombosis (DVT), residual thrombosis detected by phlebography or ultrasound has been shown to be a prognostic factor, but only in patients without thrombosis predisposing factors [22][23][24].…”

Overview of Current Evidence on the Impact of the Initial High Dose of the Direct Factor Xa Inhibitor Rivaroxaban on Thrombus Resolution in the Treatment of Venous Thromboembolism

“…3,19,25) This is important, because residual thrombosis is observed in 50% of patients with PE 1 month after the event, and around 5% of treated patients with PE develop pulmonary hypertension as a result of poor thrombus resolution. 26,27) We present here a summary of the risks posed by incomplete thrombus resolution in VTE, as well as a discussion of treatment approaches and current guidelines, and recent and emerging data on the NOACs in this regard, with a focus on rivaroxaban. Four case studies from the Darmstadt Academic Teaching Hospital, Germany, and Gunma University Hospital, Japan, which together manage over 1,000 patients with VTE per year, are also provided.…”