Association Between Asymptomatic Proximal Deep Vein Thrombosis and Mortality in Acutely Ill Medical Patients

Abstract

Background Asymptomatic proximal deep vein thrombosis (DVT) is an end point frequently used to evaluate the efficacy of anticoagulant thromboprophylaxis in medical patients. Recently, the clinical relevance of asymptomatic DVT has been challenged. Methods and Results The objective of this study was to evaluate the relationship between asymptomatic proximal DVT and all‐cause mortality (ACM) using a cohort analysis of a randomized trial for the prevention of venous thromboembolism (VTE) in acutely ill medical patients. Patients who received at least 1 dose of study drug and had an adequate compression ultrasound examination of the legs on either day 10 or day 35 were categorized into 1 of 3 cohorts: no VTE, asymptomatic proximal DVT, or symptomatic DVT. Cox proportional hazards model, with adjustment for significant independent predictors of mortality, were used to compare the incidences of ACM. Of the 7036 patients, 6776 had no VTE, 236 had asymptomatic DVT, and 24 had symptomatic VTE. The incidence of ACM was 4.8% in patients without VTE. Both asymptomatic proximal DVT (mortality, 11.4%; hazard ratio [HR], 2.31; 95% CI, 1.52–3.51; P <0.0001) and symptomatic VTE (mortality, 29.2%; HR, 9.42; 95% CI, 4.18–21.20; P <0.0001) were independently associated with significant increases in ACM. The analysis was post hoc, and ultrasound results were not available for all patients. Adjustment for baseline variables significantly associated with ACM may not fully compensate for differences. Conclusions Asymptomatic proximal DVT is associated with higher ACM than no VTE and remains a relevant end point to evaluate the efficacy of anticoagulant thromboprophylaxis in medical patients. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00571649.

Medically Ill hospitalized Patients for COVID-19 THrombosis Extended ProphyLaxis with rivaroxaban ThErapy: Rationale and Design of the MICHELLE Trial

“…Recent data consistently show that asymptomatic proximal DVT found by screening ultrasonography is strongly associated with increased mortality in hospitalized medical patients. 23 Such remains a relevant endpoint in trials of thromboprophylaxis for this patient population. 24 …”

Incidence of deep vein thrombosis through an ultrasound surveillance protocol in patients with COVID-19 pneumonia in non-ICU setting: A multicenter prospective study

“…This is unmet clinical need should be assessed with a cohort of COVID patients not screened for DVT, as controls, in order to evaluate if an ultrasonographic diagnosis (and the subsequent shift to a higher intensity of anticoagulation) is associated with different prognosis. It is worth to note that very recently Raskob et al, in a secondary analysis of the MAGELLAN trial [ 29 ], clearly showed the importance of asymptomatic proximal DVT found by CUS screening in acutely ill medical patients (including those with pneumonia/sepsis) in predicting all cause mortality which was double compared with patients without VTE.…”

Treatment-Dose LMWH versus Prophylactic/Intermediate Dose Heparins in High-Risk COVID-19 Inpatients: Rationale and Design of the HEP-COVID Trial

“…The Day 10+4 visit will occur during hospitalization or at the time of hospital discharge (if this occurs sooner than Day 10) and will include a mandatory screening Doppler lower extremity CUS and blood collection to assess laboratory values, as well as an updated list of relevant medications (Table 3). Doppler CUS is performed because there is consistent evidence that asymptomatic proximal DVT correlates with ACM in hospitalized medically ill patients, including those with pneumonia or sepsis (25). Doppler CUS also is recommended for objective diagnosis in symptomatic patients with suspected upper or lower extremity DVT.…”

“…Doppler CUS is performed because there is consistent evidence that asymptomatic proximal DVT correlates with ACM in hospitalized medically ill patients, including those with pneumonia or sepsis. 25 Doppler CUS also is recommended for objective diagnosis in symptomatic patients with suspected upper or lower extremity DVT. Where resource constraints or local institutional policies preclude use of full 5-point Doppler CUS of the lower extremities, point-of-care ultrasound using two-point compression can be substituted.…”