Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis

 

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Summary

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.

• References

• 1 De Martino RR, Wallaert JB, Rossi AP. et al. A meta-analysis of anticoagulation for calf deep venous thrombosis. J Vasc Surg 2012; 56: 228-237 e1.
  CrossrefPubMedGoogle Scholar
• 2 Kearon C, Akl EA, Comerota AJ. et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e419S-94S.
  CrossrefPubMedGoogle Scholar
• 3 Ciuti G, Grifoni E, Pavellini A. et al. Incidence and characteristics of asymptomatic distal deep vein thrombosis unexpectedly found at admission in an Internal Medicine setting. Thromb Res 2012; 130: 591-595.
  CrossrefPubMedGoogle Scholar
• 4 Anderson Jr. FA, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107 (23) (Suppl. 01) I9-16.
  CrossrefPubMedGoogle Scholar
• 5 Harrell FE. Regression modeling strategies: With applications to linear models, logistic regression, and survival analysis. 45. New York: Springer; 2001: 1-67.
  Google Scholar
• 6 Palareti G, Schellong S. Isolated distal deep vein thrombosis: what we know and what we are doing. J Thromb Haemost 2012; 10: 11-19.
  CrossrefPubMedGoogle Scholar
• 7 Galanaud JP, Quenet S, Rivron-Guillot K. et al. Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients. J Thromb Haemost 2009; 7: 2028-2034.
  CrossrefPubMedGoogle Scholar
• 8 Baglin T, Douketis J, Tosetto A. et al. Does the clinical presentation and extent of venous thrombosis predict likelihood and type of recurrence? A patient-level meta-analysis. J Thromb Haemost 2010; 8: 2436-2442.
  CrossrefPubMedGoogle Scholar
• 9 Galanaud JP, Sevestre-Pietri MA, Bosson JL. et al. Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: results from the OPTIMEV study. Thromb Haemost 2009; 102: 493-500.
  Article in Thieme ConnectPubMedGoogle Scholar
• 10 Galanaud JP, Sevestre MA, Genty C. et al. Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost 2014; 12: 436-443.
  CrossrefPubMedGoogle Scholar
• 11 Fahrni J, Husmann M, Gretener SB. et al. Assessing the risk of recurrent venous thromboembolism - a practical approach. Vasc Health Risk Manag 2015; 11: 451-459.
  PubMedGoogle Scholar
• 12 Sales CM, Haq F, Bustami R. et al. Management of isolated soleal and gastrocne-mius vein thrombosis. J Vasc Surg 2010; 52: 1251-1254.
  CrossrefPubMedGoogle Scholar
• 13 Schwarz T, Buschmann L, Beyer J. et al. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg 2010; 52: 1246-1250.
  CrossrefPubMedGoogle Scholar