Risk of recurrence of unusual site venous thromboembolism

 

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Summary

The term unusual site venous thrombosis defines uncommon clinical manifestations of venous thromboembolism occurring in sites different from the lower limbs or the lungs, with peculiar pathophysiological features and clinical history. Information on long-term outcomes of unusual site thrombosis is generally scant, because most studies are small and usually retrospective.

Recurrence rate of cerebral vein thrombosis is about 2/100 patient-years; the only identified predisposing factors have been male gender and personal history of thrombosis. Retinal vein occlusion showed a recurrence in the same eye of 2.5% and in the fellow eye of 11.9% within four years. Hypercholesterolemia, hypertriglyceridaemia and hyperhomocysteinaemia were significantly associated with recurrent events. Recurrence rates of splanchnic vein thrombosis are difficult to estimate given the heterogeneity of patient populations; higher recurrence rates are reported in the cirrhotic population (from 27% to 38.5%). Hormone therapy, myeloproliferative neoplasm or other prothrombotic states, and absence of anticoagulant therapy emerged as independent prognostic factors. Future studies should aim at better assessing the risk of recurrence in different patients subgroups and at identifying more accurate prognostic markers.

Zusammenfassung

Die Bezeichnung Venenthrombosen an ungewöhnlicher Lokalisation steht für Manifestationen venöser Thromboembolien, die außerhalb von den unteren Extremitäten oder der Lunge auftreten, und besondere pathophysiologische Eigenschaften und eine spezielle Anamnese aufweisen. Langzeitdaten über den klinischen Verlauf von Venenthrombosen an ungewöhnlicher Lokalisation sind im Allgemeinen sehr spärlich, da es sich oft um wenig umfangreiche und meistens retrospektive Studien handelt Die Rezidivrate zerebraler Venenthrombosen liegt bei ungefähr 2 pro 100 Patientenjahre; die einzigen identifizierten Prädispositionsfaktoren sind männliches Geschlecht und Thrombose in der Vorgeschichte. Bei retinalen Venenverschlüssen wurden in vier Jahren bei 2.5% Rezidive im selben Auge und bei 11.9% Rezidive im anderen Auge beobachtet. Ein signifikanter Zusammenhang bestand zwischen Rezidiven und Hypercholesterinämie, Hypertriglyzeridämie und Hyperhomocysteinämie. Die Rezidivraten splanchnischer Venenthrombosen sind schwer einzuschätzen, da die Patienten sehr heterogen sind; bei Patienten mit Zirrhose werden höhere Rezidivraten berichtet (27–38,5%). Als unabhängige prognostische Faktoren kristallisierten sich Hormontherapien, myeloproliferative Neoplasien oder andere prothrombotische Zustände sowie fehlende Antikoagulationstherapie heraus. Ziel künftiger Studien sollte sein, das Rezidivrisiko in verschiedenen Patientengruppen besser einzuschätzen und präzise Prognosemarker zu identifizieren.

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