title: The impact of residual thrombosis on the long-term outcome of patients with deep venous thrombosis treated with conventional anticoagulation.
abstract: The impact of residual vein thrombosis (RVT) on the long-term outcome of patients with deep vein thrombosis (DVT) is unknown. We assessed the incidence of recurrent venous thromboembolism (VTE), postthrombotic syndrome (PTS), arterial thrombotic events, and cancer in patients with DVT with and without RVT. For this purpose, we evaluated up to 3 years 869 consecutive patients with acute proximal DVT who had conventional anticoagulation. RVT, defined as ultrasound incompressibility of at least 4 mm in the common femoral and/or the popliteal vein after 3 months, was detected in 429 (49.4%) patients, and was more likely in males (adjusted odds ratio [OR], 1.82; 95% confidence interval [CI], 1.37-2.04), in patients with previous VTE (OR, 1.64; 95% CI, 1.06-2.54), and in those with extensive thrombosis (OR, 3.58; 95% CI, 2.19-5.86). During the 3-year follow-up, recurrent VTE developed in 84 (19.6%) patients with RVT and 43 (9.8%) patients without RVT (adjusted hazard ratio [HR], 2.03; 95% CI, 1.40-2.94); PTS in 225 (52.4%) and 118 (26.8%), respectively (HR, 2.34; 95% CI, 1.87-2.93); arterial thrombosis in 29 (6.7%) and 14 (3.2%), respectively (HR, 2.05; 95% CI, 1.08-3.88); and cancer in 21 (4.9%) and 8 (1.8%), respectively (HR, 3.09; 95% CI, 1.31-7.28). In conclusion, in patients treated with vitamin K antagonists for prevention of recurrent VTE, RVT doubles the risk of recurrent VTE, PTS, arterial thrombosis, and cancer. Males, patients with previous VTE, and those with extensive thrombosis are independent risk factors of RVT development. Studies addressing the impact of the novel direct anticoagulants on the development of RVT as well as the long-term complications of DVT are needed.
authors: Department of Cardiovascular Sciences, University Hospital of Padua, Padua, Italy.
authors: Paolo
authors: P
authors: Prandoni
authors: Department of Vascular Medicine, University of Amsterdam, Amsterdam, The Netherlands.
authors: Anthonie W A
authors: AW
authors: Lensing
authors: Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Maastricht, The Netherlands.
authors: Martin H
authors: MH
authors: Prins
authors: Department of Cardiovascular Sciences, University Hospital of Padua, Padua, Italy.
authors: Raffaele
authors: R
authors: Pesavento
authors: Department of Cardiovascular Sciences, University Hospital of Padua, Padua, Italy.
authors: Andrea
authors: A
authors: Piccioli
authors: Department of Cardiovascular Sciences, University Hospital of Padua, Padua, Italy.
authors: Maria T
authors: MT
authors: Sartori
authors: Department of Cardiovascular Sciences, University Hospital of Padua, Padua, Italy.
authors: Daniela
authors: D
authors: Tormene
authors: Department of Cardiovascular Sciences, University Hospital of Padua, Padua, Italy.
authors: Marta
authors: M
authors: Milan
authors: Department of Cardiovascular Sciences, University Hospital of Padua, Padua, Italy.
authors: Valentina
authors: V
authors: Vedovetto
authors: Department of Cardiovascular Sciences, University Hospital of Padua, Padua, Italy.
authors: Franco
authors: F
authors: Noventa
authors: Department of Medicine, University Hospital of Treviso, Treviso, Italy.
authors: Sabina
authors: S
authors: Villalta
authors: Department of Clinical Pharmacology, Medical Faculty Mannheim, University Heidelberg, Heidelberg, Germany.
authors: Job
authors: J
authors: Harenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000378:metabolism; D054070:Postthrombotic Syndrome / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000401:mortality; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000401:mortality; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K