Residual Vein Thrombosis Echogenicity Is Associated to the Risk of DVT Recurrence: A Cohort Study

Abstract

Although deep vein thrombosis (DVT) recurrence is a common late complication of the disease, there are few predictive markers to risk-stratify patients long-term after the thrombotic event. The accuracy of residual vein thrombosis (RVT) in this context is controversial, possibly due to a lack of a standardized methodology. The objective of the study was to evaluate the accuracy of RVT echogenicity as a predictive marker of late DVT recurrence. To evaluate the accuracy of RVT echogenicity as a predictive marker of late DVT recurrence. This prospective study included patients with history of DVT in the past 33 months. Ultrasound examination was performed to detect the presence of RVT, and its echogenicity was determined by calculating the grayscale median (GSM) of the images. Blood samplings were taken for plasma D-dimer levels. Patients were followed-up for 28 months and the primary end point was DVT recurrence. Deep vein thrombosis recurrence was confirmed or excluded by ultrasound during the follow-up. Fifty-six patients were included, of which 10 presented DVT recurrence during the follow-up. D-dimer levels above 630 ng/mL conferred higher risk for recurrence with a negative predictive value of 94%. The absence of RVT was a protective marker for recurrence with a negative predictive value of 100%. Also, the presence of hypoechoic RVT, determined by GSM values below 24, positively predicted 75% of DVT recurrences. Our results suggest that the persistence of RVT and, particularly, the presence of hypoechoic thrombi (GSM < 24) are predictive markers of the risk of DVT recurrence. Residual vein thrombosis echogenicity, by GSM analysis, could represent a new strategy for the evaluation of recurrence risk in patients with DVT.

Treatment Decision-Making of Secondary Prevention After Venous Thromboembolism: Data From the Real-Life START2-POST-VTE Register

“…The presence of residual vein thrombosis was a condition reported in about 20% of patients referred for extended AT; this was in line with many scientific data pointing to a relationship between the persistence of a residual thrombus and an increased risk of thrombosis recurrence. 21 – 23 …”

“…The presence of residual vein thrombosis was a condition reported in about 20% of patients referred for extended AT; this was in line with many scientific data pointing to a relationship between the persistence of a residual thrombus and an increased risk of thrombosis recurrence. [21][22][23] On the basis of positive results of clinical trials, 24,25 the attending physicians suggested to about one-fourth of the patients who discontinued AT to assume sulodexide or aspirin as a substitute treatment in the months that followed. In some patients, the therapy for extended treatment was shifted from full-to low-dose apixaban; this was supported by results obtained in the Amplify-Extension trial 26 in which low-dose apixaban (2.5 mg twice daily) proved equally effective as and safer than standard dose (5 mg twice daily) for extended treatment, while in all the remaining cases the original AT was maintained also for extended therapy.…”

A case-controlled study on AngioJet rheolytic thrombectomy and catheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis

“…The blood flow in the distal inflow tract is closely correlated to the patency rate of deep veins. 18 For patients with May-Thurner syndrome complicated with acute LEDVT, although both AngioJet and CDT can remove the thrombus, the anatomical abnormalities cannot be changed, and when only thrombectomy is performed without correcting the lesions of the iliac vein itself, this would likely cause thrombosis recurrence. Hence, the active and effective treatment of iliac vein stenosis is an important link to ensure efficacy.…”

How to Differentiate Recurrent Deep Vein Thrombosis from Postthrombotic Syndrome

“…[46][47][48][49] Residual venous obstruction in patients with treated unprovoked DVT was an overall weak predictor for recurrence according to metaanalysis data, 47,50 while results from studies in specific subsets of patients have shown an increased risk of recurrence. 40,[51][52][53] In addition to the varying use of reference examinations in clinical practice, there is no consensus for the use of residual vein obstruction measurements in predicting recurrence or a standardized methodology for the measurements. 19,22,54 In current guidelines, venography and computed tomography (CT) venography are only suggested if CUS is unavailable or results are inadequate.…”