Leg ulceration as a long-term complication of deep vein thrombosis.
OBJECTIVE
To evaluate the role of deep vein thrombosis as a cause of leg ulcers.


METHODS
A population-based, case-control study was conducted in Central and North Auckland, New Zealand. Cases comprised 241 people aged 40 to 99 years and on the electoral roll, with current leg ulcers (all types). Cases were identified by means of notification from health professionals and by self-referral. Controls were 224 people in the same age group, without leg ulcers, who were selected from the electoral roll by using a stratified random sampling process.


METHODS
The occurrence of leg ulceration as a consequence of exposure to deep vein thrombosis or being at high risk of deep vein thrombosis (that is, people with a family history of deep vein thrombosis, and/or a history of leg fracture and/or hip, leg, or foot surgery).


RESULTS
After adjustment for age, sex, and other potential confounding factors, people who had a diagnosed thromboembolism were at almost three times higher risk of having a leg ulcer (odds ratio, 2.92; 95% confidence interval (CI), 1.47 to 6.08). In addition, people who had been at high risk of a venous thrombosis but were not diagnosed with this condition (eg, people with a history of major leg surgery) were also at increased risk of ulceration (odds ratio, 2.25; 95% CI, 1.49-3.42). Overall, 56% (95% CI, 33% - 71%) of leg ulcers were attributed to being at high risk of deep vein thrombosis.


CONCLUSIONS
Deep vein thrombosis and factors that place people at high risk of deep vein thrombosis are an important cause of leg ulcers in older people. This finding strengthens the rationale for the routine and long-term use of thromboprophylaxis, particularly in high-risk patients.
Walker
Natalie
N
Clinical Trials Research Unit, Department of Medicine, University of Auckland, PB 92019, Auckland, New Zealand. n.walker@ctru.auckland.ac.nz
Rodgers
Anthony
A
Birchall
Nicholas
N
Norton
Robyn
R
MacMahon
Stephen
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology