Predictors of Recurrence After Deep Vein Thrombosis and Pulmonary Embolism

Heit, John A.; Mohr, David N.; Silverstein, Marc D.; Petterson, Tanya M.; O’Fallon, W. Michael; Melton, L. Joseph

doi:10.1001/archinte.160.6.761

Cited by 1,013 publications

(755 citation statements)

References 36 publications

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“…Long-term anticoagulant treatment is highly effective in preventing recurrent venous thromboembolism (VTE) in patients with idiopathic deep vein thrombosis (DVT) of the lower limbs [1][2][3] but is associated with an increased risk for major bleeding that may offset the benefits of anticoagulation [4]. Since the risk of recurrent VTE is believed to gradually diminish over time, many patients with idiopathic DVT may not require prolonged treatment with a vitamin K antagonist (VKA) [5,6].…”

Section: Introductionmentioning

confidence: 99%

Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

et al. 2011

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The safest duration of anticoagulation after idiopathic deep vein thrombosis (DVT) is unknown. We conducted a prospective study to assess the optimal duration of vitamin K antagonist (VKA) therapy considering the risk of recurrence of thrombosis according to residual vein thrombosis (RVT). Patients with a first unprovoked DVT were evaluated for the presence of RVT after 3 months of VKA administration; those without RVT suspended VKA, while those with RVT continued oral anticoagulation for up to 2 years. Recurrent thrombosis and/or bleeding events were recorded during treatment (RVT group) and 1 year after VKA withdrawal (both groups). Among 409 patients evaluated for unprovoked DVT, 33.2% (136 of 409 patients) did not have RVT and VKA was stopped. The remaining 273 (66.8%) patients with RVT received anticoagulants for an additional 21 months; during this period of treatment, recurrent venous thromboembolism and major bleeding occurred in 4.7% and 1.1% of patients, respectively. After VKA suspension, the rates of recurrent thrombotic events were 1.4% and 10.4% in the no-RVT and RVT groups, respectively (relative risk 5 7.4; 95% confidence interval 5 4.9-9.9). These results indicate that in patients without RVT, a short period of treatment with a VKA is sufficient; in those with persistent RVT, treatment extended to 2 years substantially reduces, but does not eliminate, the risk of recurrent thrombosis. Am. J. Hematol. 86:914-917, 2011. V

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Section: Introductionmentioning

confidence: 99%

Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

et al. 2011

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“…One study among patients >45 years age found that the 28-day case fatality rate after the first VTE event among all patients studied was 11%; among patients with cancer related VTE, it was 25% [3] . Approximately 30% patients with VTE may have recurrent events within 10 years [4] . The occurrence of VTE also results in substantial health care costs.…”

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confidence: 99%

Emergency department visits by patients with venous thromboembolism, 1998-2009

Yusuf¹,

Tsai²,

Siddiqi³

et al. 2012

JHA

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Background: Substantial morbidity and mortality may result from venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Many VTE cases are diagnosed in outpatient settings, such as emergency departments. The purpose of this study was to estimate and characterize emergency department visits by patients with a primary diagnosis of VTE. Methods:Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 1998-2009 were analyzed. NHAMCS uses a complex multistage design to sample non-federal short-term care hospitals across the United States. Emergency department visits with a primary diagnosis of VTE were identified using ICD-9-CM codes indicating a primary diagnosis of DVT or PE.Results: Between 2006-2009, an annual average of 201,000 (95% confidence interval [CI]: 152,000-251,000) emergency department visits were made in the U.S. by patients with a primary diagnosis of VTE as per the criteria used in this study, which was a rate of approximately 67 (95% CI 50-83) per 100,000 population. The rates during 1998-2001 and 2002-2005 were 31 (95% CI 21-40) and 46 (95% CI 35-57), respectively. The rate of visits with a primary diagnosis of VTE was higher among patients >61 years of age, when compared to younger patients. Among visits between 1998-2009, selected characteristics that differed between visits by patents with and without a primary diagnosis of VTE included the patient having been discharged from a hospital in the past seven days (11.7%, vs. 2.1%, p<0.01). Conclusion:A substantial number of emergency department visits are made by patients with a primary diagnosis of VTE. Groups with higher likelihood of VTE related visits may include older adults and those recently discharged from a hospital.

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“…Patients with malignant neoplasm who are complicated by thromboembolism are at increased risk for recurrence. 5 The indication, efficacy and safety of vena caval filters in the prevention of pulmonary embolism in patient with DVT is still controversial. 6,7 In the present case, platelet scintigraphy revealed the accumulation of platelets at the site of the filter, which suggested the growth of thrombus and a risk of recurrent pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Thromboembolism-Evaluating the Indication and Effect of a Vena Caval Filter With Indium-111-Platelet Scintigraphy-

Yagi

Oriuchi²,

Sato³

et al. 2004

Circ J

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eep venous thrombosis (DVT) of the lower extremity is usually diagnosed with ascending contrast venography and ultrasonography. In the present case, we used platelets labelled with In-111 to detect thrombus formation 1,2 because a significant correlation between this technique and contrast venography in the detection of DVT has been reported. 3 Case ReportA 63-year-old woman presented to a local hospital complaining of left chest pain, which was found to be caused by a small left pleural effusion. Subsequently, the amount of pleural effusion increased and cytology revealed adenocarcinoma cells. She was referred to Gunma University Hospital for further examination and treatment. Her past medical history was unremarkable except for appendicitis and myoma of the uterus.On admission, physical findings were coarse crackles of the left lung, and the swelling, local heat, edema and superficial venous dilatation of the right lower leg, which were thought to be caused by thrombophlebitis.Initial laboratory values were elevated: hemoglobin 10.7 g/dl, white cell count 12,200 / l, total protein 6.2 g/dl, total bilirubin 0. 2.1 mg/dl (normal: <0.3), prothrombin time 66%, fibrinogen 115 mg/dl (normal: 200-400), fibrin degradation product 173.4 g/ml (normal: <10), D-dimer 49 g/ml (normal: <0.2), carcinoembryonic antigen 4.3 ng/ml (normal: <2.5), CA125 271 U/ml (normal: <35). Arterial blood-gas analysis revealed normal PaO2 (96.8 mmHg) and PaCO2 (40.8 mmHg) concentrations.A computed tomography (CT) scan of the chest showed left pleural effusion and a questionable enhanced lesion in the left lingular segment, which was suspected to be lung cancer. She had been diagnosed as having thrombophlebitis Circ J 2004; 68: 599 -601 (Received March 22, 2002; revised manuscript received October 21, 2002; accepted November 11, 2002 A 63-year-old woman complained of chest pain and was referred to hospital where she was found to have left pleural effusion and swelling, local heat and edema of the right lower leg. Initial pulmonary perfusion scintigraphy demonstrated multiple defects and pulmonary thromboembolism (PTE) was confirmed during the anticoagulant and thrombolytic therapy against thrombophlebitis. A Greenfield filter was inserted in the inferior vena cava to prevent recurrence of PTE from the thrombosis that was resistant to therapy. In-111-labeled platelet scintigraphy (platelet scintigraphy) showed abnormal uptake of platelets in the chest, femoral veins and abdomen, which suggested active thrombus formation in those regions, including the filter, and a risk of recurrent PTE. Therefore, the thrombolytic therapy was terminated and the anticoagulant therapy intensified. A computed tomography (CT) scan revealed thrombus at the filter, which was markedly decreased 1 month later on platelet scintigraphy. Pulmonary ventilation and perfusion scintigraphy revealed remarkable improvement of the PTE. In this case, platelet scintigraphy complemented CT in demonstrating the activity and localization of the thrombus and can be used to evaluate ...

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Predictors of Recurrence After Deep Vein Thrombosis and Pulmonary Embolism

Cited by 1,013 publications

References 36 publications

Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

Emergency department visits by patients with venous thromboembolism, 1998-2009

Pulmonary Thromboembolism-Evaluating the Indication and Effect of a Vena Caval Filter With Indium-111-Platelet Scintigraphy-

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