title: Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis.
abstract: Isolated distal deep-vein thrombosis (DDVT) of the lower extremities can be associated with subsequent proximal deep-vein thrombosis (PDVT) and/or acute pulmonary embolism (PE). We aimed to develop a model predicting the probability of developing PDVT and/or PE within three months after an isolated episode of DDVT. We conducted a retrospective cohort study of patients with symptomatic DDVT confirmed by lower extremity vein ultrasounds between 2001-2012 in the Cleveland Clinic Health System. We reviewed all the ultrasounds, chest ventilation/perfusion and computed tomography scans ordered within three months after the initial DDVT to determine the incidence of PDVT and/or PE. A multiple logistic regression model was built to predict the rate of developing these complications. The final model included 450 patients with isolated DDVT. Within three months, 30 (7 %) patients developed an episode of PDVT and/or PE. Only two factors predicted subsequent thromboembolic complications: inpatient status (OR, 6.38; 95 % CI, 2.17 to 18.78) and age (OR, 1.02 per year; 95 % CI, 0.99 to 1.05). The final model had a bootstrap bias-corrected c-statistic of 0.72 with a 95 % CI (0.64 to 0.79). Outpatients were at low risk (< 4 %) of developing PDVT/PE. Inpatients aged ≥ 60 years were at high risk (> 10 %). Inpatients aged < 60 were at intermediate risk. We created a simple model that can be used to risk stratify patients with isolated DDVT based on inpatient status and age. The model might be used to choose between anticoagulation and monitoring with serial ultrasounds.
authors.affiliation: Andrei Brateanu MD, Cleveland Clinic, Mail Code NA10, 9500 Euclid Avenue, Cleveland, OH 44195, USA, Tel.: +1 216 407 4374, E-mail: abratean@ccf.org.
authors.forename: Andrei
authors.initials: A
authors.lastname: Brateanu
authors.forename: Krishna
authors.initials: K
authors.lastname: Patel
authors.forename: Kevin
authors.initials: K
authors.lastname: Chagin
authors.forename: Pichapong
authors.initials: P
authors.lastname: Tunsupon
authors.forename: Pojchawan
authors.initials: P
authors.lastname: Yampikulsakul
authors.forename: Gautam V
authors.initials: GV
authors.lastname: Shah
authors.forename: Sintawat
authors.initials: S
authors.lastname: Wangsiricharoen
authors.forename: Linda
authors.initials: L
authors.lastname: Amah
authors.forename: Joshua
authors.initials: J
authors.lastname: Allen
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shapiro
authors.forename: Neha
authors.initials: N
authors.lastname: Gupta
authors.forename: Lillie
authors.initials: L
authors.lastname: Morgan
authors.forename: Rahul
authors.initials: R
authors.lastname: Kumar
authors.forename: Craig
authors.initials: C
authors.lastname: Nielsen
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011336:Probability; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis
chemical_list: D000925:Anticoagulants
keywords: Deep-vein thrombosis; distal deep-vein thrombosis; proximal deep-vein thrombosis; pulmonary embolism