title: Deep vein thrombosis risk stratification.
abstract: Pulmonary thromboembolism (PTE) is a life-threatening disease which always presents in patients with deep vein thrombosis (DVT). There are few statements in guidelines regarding indications for anticoagulation based on the location of DVT. We investigated whether the relative risk of PTE depends on thrombus location and bleeding complications with anticoagulation therapy. Between January 1 and July 10, 2007, 461 patients underwent lower extremity venous ultrasound studies, and 129 patients were diagnosed as DVT (60 males, 66.9 ± 13.3 years). We retrospectively studied the incidence of PTE and bleeding complications associated with anticoagulation therapy. Average follow-up period was 536 ± 324 days. Above and below knee thrombosis was present in 60 and 69 patients, respectively. Warfarin was administered in 60 patients. Nine patients developed PTE. Multivariate analysis showed the absence of anticoagulation therapy and location of DVT (above knee) to be significantly correlated with onset of PTE (anticoagulation; P < 0.01, location; P = 0.02). However, the incidence of bleeding was not significantly different between above knee and below knee vein thrombosis (P = 0.72). In conclusion, below knee vein thrombosis carries a relatively low risk of PTE, but the incidence of bleeding complications does not depend on thrombosis location. This suggests that the indication of anticoagulation therapy should be based on DVT location.
authors.affiliation: Department of Cardiovascular Center Medicine, Toranomon Hospital, Tokyo Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nitta
authors.forename: Haruo
authors.initials: H
authors.lastname: Mitani
authors.forename: Rieko
authors.initials: R
authors.lastname: Ishimura
authors.forename: Manabu
authors.initials: M
authors.lastname: Moriya
authors.forename: Yo
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Sugao
authors.initials: S
authors.lastname: Ishiwata
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Minoru
authors.initials: M
authors.lastname: Ohno
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000925:Anticoagulants