The Impact of Residual Thrombosis on the Long-Term Outcome of Patients with Deep Venous Thrombosis Treated with Conventional Anticoagulation

Prandoni, Paolo; Lensing, Anthonie W. A.; Prins, Martin H.; Pesavento, Raffaele; Piccioli, Andrea; Sartori, Maria Teresa; Tormene, Daniela; Milan, Marta; Vedovetto, Valentina; Noventa, Franco; Villalta, Sabina; Harenberg, Job

doi:10.1055/s-0035-1544161

Cited by 80 publications

(15 citation statements)

References 23 publications

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“…Residual vein thrombosis (RVT) is associated with a doubled risk of recurrent VTE compared to those without RVT, suggesting that mechanical thrombosis removal may be warranted [37]. …”

Section: Medical Management Of Dvt and Pementioning

confidence: 99%

“…A recent retrospective study of patients undergoing Trellis-8 Peripheral Infusion System (Covidien, Mansfield, MA) and thrombectomy, after complete IVC filter occlusion, showed that all demonstrated caval patency at a median of 7.8 months after procedure, though only 3 patients had imaging follow-up. No thromboembolic complications developed [37]. …”

Section: Endovascular Management Of Vtementioning

confidence: 99%

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Pathogenesis of Thromboembolism and Endovascular Management

et al. 2017

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Venous thromboembolism (VTE), a disease that includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT) is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT) comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted.

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“…Residual vein thrombosis (RVT) is associated with a doubled risk of recurrent VTE compared to those without RVT, suggesting that mechanical thrombosis removal may be warranted [37]. …”

Section: Medical Management Of Dvt and Pementioning

confidence: 99%

Section: Endovascular Management Of Vtementioning

confidence: 99%

Pathogenesis of Thromboembolism and Endovascular Management

et al. 2017

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“…Remarkable, yet without difference between the groups studied, was the high percentage of male patients (82.1%) and thrombosis with a right-sided (57.1%) thrombus localisation [ 5 , 26 , 27 ]. Also the incidence of PTS was high (60.7%) compared to the general post-thrombotic population [ 6 – 8 ] and was mainly based on high objective scores.…”

Section: Discussionmentioning

confidence: 99%

“…PTS is a chronic condition characterised by a painful, swollen limb with paraesthesia, skin changes, venous claudication, and ultimately venous ulceration. It develops in 20–50% of all DVT patients [ 6 – 8 ] and is associated with a negative impact on the quality of life (QoL) [ 9 ] and increased health care costs [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of venous obstructions in (recurrent) venous thromboembolism: a case-control study

et al. 2020

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Background The role of venous obstructions as a risk factor for recurrent venous thromboembolism has never been evaluated. This study aimed to determine whether there is a difference in prevalence of venous obstructions between patients with and without recurrent venous thromboembolism. Furthermore, its influence on the development of post-thrombotic syndrome and patient-reported quality of life was assessed. Methods This matched nested case-control study included 32 patients with recurrent venous thromboembolism (26 recurrent deep-vein thrombosis and 6 pulmonary embolism) from an existing prospective cohort of deep-vein thrombosis patients and compared them to 24 age and sex matched deep-vein thrombosis patients without recurrent venous thromboembolism. All participants received standard post-thrombotic management and underwent an additional extensive duplex ultrasonography. Post-thrombotic syndrome was assessed by the Villalta-scale and quality of life was measured using the SF36v2 and VEINES-QOL/Sym-questionnaires. Results Venous obstruction was found in 6 patients (18.8%) with recurrent venous thromboembolism compared to 5 patients (20.8%) without recurrent venous thromboembolism (Odds ratio 0.88, 95%CI 0.23–3.30, p = 1.000). After a median follow-up of 60.0 months (IQR 41.3–103.5) the mean Villalta-score was 5.55 ± 3.02 versus 5.26 ± 2.63 (p = 0.909) and post-thrombotic syndrome developed in 20 (62.5%) versus 14 (58.3%) patients, respectively (Odds ratio 1.19, 95%CI 0.40–3.51, p = 0.752). If venous obstruction was present, it was mainly located in the common iliac vein (n = 7, 63.6%). In patients with an objectified venous obstruction the mean Villalta-score was 5.11 ± 2.80 versus 5.49 ± 2.87 in patients without venous obstruction (p = 0.639). Post-thrombotic syndrome developed in 6 (54.5%) versus 28 (62.2%) patients, respectively (Odds ratio 1.37, 95%CI 0.36–5.20, p = 0.736). No significant differences were seen regarding patient-reported quality of life between either groups. Conclusions In this exploratory case-control study patients with recurrent venous thromboembolism did not have a higher prevalence of venous obstruction compared to patients without recurrent venous thromboembolism. The presence of recurrent venous thromboembolism or venous obstruction had no impact on the development of post-thrombotic syndrome or the patient-reported quality of life.

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“…Deep vein thrombosis is prevalent in patients with diabete s (17), and it is regarded to be a prothrombotic state with complications including pulmonary embolism and post-thrombotic syndrome (PTS). Prandoni et al reported a signi cantly higher rate of subsequent arterial events in patients with DVT and residual thrombus (18), and that this could lead to PTS complicated with edema, venous stasis, ulceration, and thrombophlebitis with focal in ammation. Most previous studies have investigated associations between VTE and atherosclerotic cardiovascular disease in the general population, however few studies have focused on potentially life-threatening limb arterial complications in patients with diabetes in this context.…”

mentioning

confidence: 99%

Deep vein thrombosis and major adverse limb events in diabetic patients: a population-based cohort study

Wang¹,

Chen²,

Chung³

et al. 2020

Preprint

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Background Little is known about the association between deep vein thrombosis (DVT) and arterial complications in patients with type 2 diabetes. The aim of this retrospective cohort study was to assess the influence of prior DVT on major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) in patients with type 2 diabetes. Methods Patients with type 2 diabetes with or without a history of DVT hospitalization from 2001 to 2013 were identified in the National Health Insurance Research Database of Taiwan and included in this study. Propensity score matching was used to balance the baseline characteristics between groups. Cox proportional and Fine and Gray subdistribution hazard models were used to examine association a between history of DVT and the risks of MALEs and MACEs. Results During a mean follow-up of 5.2 years (standard deviation: 3.9 years), the DVT group (n = 2017) had a higher risk of MALE composite outcome (8.4% vs. 5.2%; subdistribution hazard ratio [SHR] 1.60, 95% CI 1.34–1.90). Among the individual components, the DVT group had higher risks of foot ulcer (5.2% vs. 2.6%, SHR 1.96, 95% CI 1.57–2.45), gangrene (3.4% vs. 2.3%, SHR 1.44, 95% CI 1.10–1.90) and amputation (2.5% vs. 1.7%; SHR 1.42, 95% CI 1.03–1.95). Conclusions The presence of DVT may be associated with an increased risk of MALEs, major amputation, and thromboembolism, contributing to a higher risk of mortality in patients with type 2 diabetes.

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The Impact of Residual Thrombosis on the Long-Term Outcome of Patients with Deep Venous Thrombosis Treated with Conventional Anticoagulation

Cited by 80 publications

References 23 publications

Pathogenesis of Thromboembolism and Endovascular Management

Pathogenesis of Thromboembolism and Endovascular Management

Prevalence of venous obstructions in (recurrent) venous thromboembolism: a case-control study

Deep vein thrombosis and major adverse limb events in diabetic patients: a population-based cohort study

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