A multicenter prospective study of risk factors and treatment of unusual site thrombosis.
Unusual site deep vein thrombosis (USDVT) is an uncommon form of venous thromboembolism (VTE) with heterogeneity in pathophysiology and clinical features. While the need for anticoagulation treatment is generally accepted, there is little data on optimal USDVT treatment. The TRUST study aimed to characterize the epidemiology, treatment and outcomes of USDVT. From 2008 to 2012, 152 patients were prospectively enrolled at 4 Canadian centers. After baseline, patients were followed at 6, 12 and 24months. There were 97 (64%) cases of splanchnic, 33 (22%) cerebral, 14 (9%) jugular, 6 (4%) ovarian and 2 (1%) renal vein thrombosis. Mean age was 52.9years and 113 (74%) cases were symptomatic. Of 72 (47%) patients tested as part of clinical care, 22 (31%) were diagnosed with new thrombophilia. Of 138 patients evaluated in follow-up, 66 (48%) completed at least 6months of anticoagulation. Estrogen exposure or inflammatory conditions preceding USDVT were commonly associated with treatment discontinuation before 6months, while previous VTE was associated with continuing anticoagulation beyond 6months. During follow-up, there were 22 (16%) deaths (20 from cancer), 4 (3%) cases of recurrent VTE and no fatal bleeding events. Despite half of USDVT patients receiving <6months of anticoagulation, the rate of VTE recurrence was low and anticoagulant treatment appears safe. Thrombophilia testing was common and thrombophilia prevalence was high. Further research is needed to determine the optimal investigation and management of USDVT.
Medicine, Division of Hematology, McGill University, Montreal, Canada.
Kim
K
Ma
Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada.
Phillip
P
Wells
Clinical Epidemiology, Lady Davis Institute, Montreal, Canada.
Charlotte
C
Guzman
Medicine and Clinical Epidemiology, Dalhousie University, Halifax, Canada.
David
D
Anderson
Medicine, Division of Hematology, McGill University, Montreal, Canada.
Mark
M
Blostein
Medicine, Respiratory Division, Jewish General Hospital, Montreal, Canada.
Andrew
A
Hirsch
Medicine and Clinical Epidemiology, Division of Hematology, University of Western Ontario, London, Canada.
Alejandro
A
Lazo-Langner
Medicine, Division of Hematology, University of Western Ontario, London, Canada.
Michael J
MJ
Kovacs
Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada.
Marc
M
Rodger
Medicine and Clinical Epidemiology, Jewish General Hospital, Montreal, Canada.
Vicky
V
Tagalakis
Medicine and Clinical Epidemiology, Jewish General Hospital, Montreal, Canada. Electronic address: susan.kahn@mcgill.ca.
Susan R
SR
Kahn
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology
D000925:Anticoagulants
Risk factors; Treatment; Unusual site thrombosis; Venous thromboembolism