title: Residual Vein Thrombosis Echogenicity Is Associated to the Risk of DVT Recurrence: A Cohort Study.
abstract: Although deep vein thrombosis (DVT) recurrence is a common late complication of the disease, there are few predictive markers to risk-stratify patients long-term after the thrombotic event. The accuracy of residual vein thrombosis (RVT) in this context is controversial, possibly due to a lack of a standardized methodology. The objective of the study was to evaluate the accuracy of RVT echogenicity as a predictive marker of late DVT recurrence. To evaluate the accuracy of RVT echogenicity as a predictive marker of late DVT recurrence. This prospective study included patients with history of DVT in the past 33 months. Ultrasound examination was performed to detect the presence of RVT, and its echogenicity was determined by calculating the grayscale median (GSM) of the images. Blood samplings were taken for plasma D-dimer levels. Patients were followed-up for 28 months and the primary end point was DVT recurrence. Deep vein thrombosis recurrence was confirmed or excluded by ultrasound during the follow-up. Fifty-six patients were included, of which 10 presented DVT recurrence during the follow-up. D-dimer levels above 630 ng/mL conferred higher risk for recurrence with a negative predictive value of 94%. The absence of RVT was a protective marker for recurrence with a negative predictive value of 100%. Also, the presence of hypoechoic RVT, determined by GSM values below 24, positively predicted 75% of DVT recurrences. Our results suggest that the persistence of RVT and, particularly, the presence of hypoechoic thrombi (GSM < 24) are predictive markers of the risk of DVT recurrence. Residual vein thrombosis echogenicity, by GSM analysis, could represent a new strategy for the evaluation of recurrence risk in patients with DVT.
authors.affiliation: 1 Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Bruna M
authors.initials: BM
authors.lastname: Mazetto
authors.affiliation: 1 Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil.|2 Department of Clinical Pathology, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Fernanda L A
authors.initials: FLA
authors.lastname: Orsi
authors.affiliation: 1 Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Sandra A F
authors.initials: SAF
authors.lastname: Silveira
authors.affiliation: 1 Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Bittar
authors.affiliation: 1 Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Mariane M C
authors.initials: MMC
authors.lastname: Flores-Nascimento
authors.affiliation: 1 Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Kiara C S
authors.initials: KCS
authors.lastname: Zapponi
authors.affiliation: 1 Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Marina P
authors.initials: MP
authors.lastname: Colella
authors.affiliation: 1 Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Erich V
authors.initials: EV
authors.lastname: de Paula
authors.affiliation: 1 Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Annichino-Bizzacchi
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D014463:Ultrasonography / Q000379:methods; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: deep venous thrombosis; recurrence; residual vein thrombosis; ultrasound