Post‐treatment residual thrombus increases the risk of recurrent deep vein thrombosis and mortality

Abstract

Summary. Background: Recurrent thromboembolic events after an initial deep vein thrombosis (DVT) are relatively frequent. Residual thrombus in the affected veins on ultrasound scan at the completion of anticoagulant therapy has been described as a recurrence risk factor, and may have utility in stratifying those patients at risk. Objectives: The aims of the study were to correlate the risk of recurrence of DVT with the results of ultrasound at completion of oral anticoagulant therapy. A secondary aim was to review the mortality in this population. Patients: A cohort of 316 DVT patients was included. The patients were divided into those with completely clear vessels on follow-up scan (45%) and those with residual thrombus identified (55%). Results: The cumulative incidence of recurrence was 10% by 2 years and 23% by 5 years. Patients with residual thrombus on follow-up ultrasound were at higher risk of recurrence (hazard ratio [HR] 2.2, 1.19-4.21; P ¼ 0.012) which remained significant after multivariate adjustment for age, gender and malignancy (HR 2.2, 1.15-4.17; P ¼ 0.018). During follow-up, the cumulative mortality was 12% at 2 years and 27% by 5 years. The risk of death was increased in patients with residual thrombus on follow-up scan (HR 3.9, 1.93-7.71; P < 0.001) and this risk persisted after multivariate analysis of age, gender and malignancy (2.8, 1.37-5.72; P ¼ 0.005). The majority of deaths were due to malignancy (68%) however 10 (18%) died from vascular causes. There was a trend towards increased vascular death in the patients with residual thrombus on follow-up ultrasound scan, which did not reach significance (HR 4.1,; P ¼ 0.13). Conclusions: Consistent with previous cohort studies, recurrence risk is increased in patients with residual thrombus on ultrasound. The increased risk of death in patients with residual thrombus, with a trend towards increased vascular death, may suggest that failure of thrombus resolution is a marker of more global vascular dysfunction.

Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

“…It has been previously shown that a considerable number of recurrences can be seen in the opposite leg or present as PE [1,3,5]. Young et al [5] suggested that residual thrombus in DVT may be a marker for a generalized procoagulant diathesis.…”

“…Young et al [5] suggested that residual thrombus in DVT may be a marker for a generalized procoagulant diathesis. Higher thrombogenic state of the patients may be the possible mechanism responsible for platelet activation and MPVand PDW elevation in patients with RVT [19][20][21].…”

“…RVT has been reported to be an independent risk factor for recurrent thromboembolic event and is generally considered a marker of hypercoagulability. Thus, RVT can be used for the risk stratification of patients with DVT and plays a vital role in determining the duration of anticoagulation [1,[3][4][5]. Therefore, it is of high clinical importance to distinguish patients with RVT from those who fully recovered.…”

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

“…Sarasin and Bounameaux [38] calculated a theoretical recurrence rate of 0.9% per month after discontinuing anticoagulant therapy for proximal DVT, similar to annual recurrence rates of 7.0%-12.9% [39,40]. The risk of recurrent VTE is highest over the first 6-12 months after the index event, although cumulative rates can reach 24% at 5 years and 30% at 8 years after initial presentation [40][41][42][43]. The risk of recurrence is at least as great in the contralateral as in the ipsilateral extremity [42].…”

Thrombophilia States and Markers of Coagulation Activation in the Prediction of Pediatric Venous Thromboembolic Outcomes: A Comparative Analysis with Respect to Adult Evidence

“…While clinical factors such as obesity, 14 persistence of thrombosis following a conventional duration of anticoagulation, 15 use of graduated compression stockings, 16 and acute thrombolytic therapy 17 have each been established as outcome predictors with respect to PTS and/or recurrent VTE in adults, only thrombolytic therapy 13 and complete veno-occlusion 18 have been systematically studied and shown prognostic value within the framework of a cohort study or clinical trial of VTE in children. With regard to laboratory-based risk factors, as discussed in detail in this review, evidence has accumulated (albeit limited in some instances) for the association of potent inherited thrombophilia states (e.g., homozygous factor V Leiden or prothrombin polymorphisms, severe deficiency of intrinsic anticoagulants), persistent antiphospholipid antibodies (APA) and the APA syndrome (APAS), and markers of coagulation activation (specifically, elevated FVIII activity and D-dimer levels) with thrombotic outcomes such as PTS and recurrent VTE in children and/or adults.…”