Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study

Abstract

Key Points• In the 3 months after isolated SVT, the risk of a deep venous event or pulmonary embolism is 3.4%.• This risk remains fivefold increased more than 5 years after the superficial event.Recently, it has become apparent that superficial vein thrombosis (SVT) can have serious complications. However, the magnitude of the risk of subsequent deep venous and arterial thrombotic events remains unknown. We examined this in a nationwide population-based setting during a period when SVT was not treated routinely with anticoagulants. The Danish National Registry of Patients, covering all Danish hospitals, was used to identify 10 973 patients with a first-time diagnosis of SVT between 1980 and 2012. A comparison cohort of 515 067 subjects, matched by age, gender, and calendar year, was selected from the general Danish population. Outcomes were venous thromboembolism, acute myocardial infarction, ischemic stroke, and death. During median follow-up of 7 years, the incidence rate of venous thromboembolism was 18.0/1000 person-years (95% confidence interval [CI], 17.2-18.9). The highest risk occurred in the first 3 months (3.4%; 95% CI, 3.0-3.7). Compared with the general population, the hazard ratio was 71.4 (95% CI, 60.2-84.7) in this period, steadily decreasing to 5.1 (95% CI 4.6-5.5), 5 years after the SVT. The hazard ratios for acute myocardial infarction, stroke, and death were 1.2 (95% CI, 1.1-1.3), 1.3 (95% CI, 1.2-1.4), and 1.3 (95% CI, 1.2-1.3), respectively, with the highest risk also shortly after SVT. These data indicate the prognostic importance of SVT and may form the basis for clinical decisionmaking regarding anticoagulation. (Blood. 2015;125(2):229-235)

A clinical score to rule out the concomitant presence of deep vein thrombosis in patients presenting with superficial vein thrombosis: The ICARO study

“…Although it has been traditionally considered a relatively benign disease, a number of recent studies have suggested a not uncommon concomitant presence of DVT and/or PE in these patients [5,[13][14][15] and a non-negligible risk of recurrence at follow up [16,7], questioning the benign nature of this disease. It is important to diagnose DVT when present in patients with SVT because patients with an isolated SVT and patients with a concomitant major thromboembolic disease may have a different clinical history and, according to recent guidelines [17], a less aggressive therapy with six weeks of prophylactic doses of fondaparinux appear to be effective in preventing major thromboembolic complication and SVT recurrence in the former group [18] whereas at least three months of therapeutic doses of antithrombotic therapy are necessary in the latter group.…”

“…It has become recently more clear, however, that SVT may be a manifestation of a systemic tendency to thrombosis, with a non-negligible risk of recurrence or concomitant DVT or PE at the Thrombosis Research xxx (2015) xxx-xxx time of SVT diagnosis [7]. Unfortunately, available data on this association are not conclusive, ranging between 6% and 36% for concomitant DVT and up to 33% for PE [1,8].…”

Epidemiology of venous thromboembolism

“…120 Other risk factors for incident VTE include central vein catheterization or transvenous pacemaker placement, prior superficial vein thrombosis, urinary tract infection, increased baseline plasma fibrin d -dimer, and family history of VTE, whereas patients with chronic liver disease have a reduced risk of VTE. 121–127 Compared with residents in the community, hospitalized patients have >100-fold increased incidence of VTE. 128 Hospitalization and nursing-home residence together account for almost 60% of incident VTE events in the community.…”

Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome Associated with Risk of Pulmonary Embolism

“…High mortality is associated with a delayed diagnosis of acute PE [3]. Recent studies have indicated that the predisposing factors for PE include numerous underlying diseases such as obstructive airway disease (causing asthma [4] and chronic obstructive pulmonary disease [COPD] [5]), atherosclerosis [6] (causing hypertension, diabetes [7], and stroke), heart failure [8] and cancer [9]. …”