Long-term risk of venous thromboembolism recurrence after isolated superficial vein thrombosis.
Essentials Long-term risk of recurrence of isolated superficial vein thrombosis (SVT) is under-studied. We analyzed data from a cohort of first SVT and proximal deep vein thrombosis (DVT) without cancer. The risk of recurrence as DVT or pulmonary embolism is twice lower in SVT patients. However, overall risk of recurrence is similar between SVT and proximal DVT patients. Click to hear Dr Decousus' perspective on superficial vein thrombosis SUMMARY: Background Isolated superficial vein thrombosis (iSVT) (without concomitant deep vein thrombosis [DVT] or pulmonary embolism [PE]) is a frequent event, but available data on long-term outcomes are scarce and retrospective. Therefore, we aimed to determine prospectively the risk and type of venous thromboembolism (VTE) recurrence after iSVT and compare them with those of proximal DVT. Methods Using data from the prospective, multicenter, observational, OPTIMEV study, we assessed, at 3 years and after anticoagulants were stopped, the incidence and the type of VTE recurrence (iSVT/DVT/PE) of patients with a first objectively confirmed iSVT without cancer (n = 285), and compared these with those of patients with a first proximal DVT without cancer (n = 262). Results As compared with proximal DVT patients, iSVT patients had a similar overall incidence of VTE recurrence (5.4% per patient-year [PY] versus 6.5% per PY, adjusted hazard ratio [aHR] 0.9, 95% confidence interval [CI] 0.5-1.6), but iSVT recurred six times more often as iSVT (2.7% versus 0.6%, aHR 5.9, 95% CI 1.3-27.1) and 2.5 times less often as deep-VTE events (2.5% versus 5.9%, aHR 0.4, 95% CI 0.2-0.9). Varicose vein status did not influence the risk or the type of VTE recurrence. Saphenian junction involvement by iSVT was not associated with a higher risk of recurrence (5.2% per PY versus 5.4% per PY), but was associated with recurrence exclusively as deep-VTE events. Conclusion In patients with a first iSVT without cancer, after stopping anticoagulants, the incidence of deep-VTE recurrence is half that of DVT patients, but the overall risk of recurrence is similar. Ssaphenian junction involvement seems to influence the risk of deep-VTE recurrence, whereas varicose vein status has no impact or a low impact on VTE recurrence.
Department of Internal Medicine and Clinical Investigation Center, Montpellier University Hospital, Montpellier University, Montpellier, France.
J-P
JP
Galanaud
Department of Vascular Medicine, Amiens University Hospital, Amiens, France.
M-A
MA
Sevestre
Department of Vascular Medicine, Grenoble University Hospital, Grenoble, France.
G
G
Pernod
Department of Medicine, McGill University and Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Canada.
S R
SR
Kahn
Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and, TIMC-IMAG, Grenoble, France.
C
C
Genty
Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and, TIMC-IMAG, Grenoble, France.
H
H
Terrisse
Vascular medicine physician, Clapiers, France.
D
D
Brisot
Vascular medicine physician, Bourgoin-Jallieu, France.
J-L
JL
Gillet
Department of Internal Medicine and Clinical Investigation Center, Montpellier University Hospital, Montpellier University, Montpellier, France.
I
I
Quéré
Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and, TIMC-IMAG, Grenoble, France.
J-L
JL
Bosson
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D014680:Veins / Q000473:pathology*; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control
D000925:Anticoagulants
epidemiologic studies; recurrence; superficial venous thrombosis; thrombophlebitis; venous thrombosis