Impact of Thrombus Sidedness on Presentation and Outcomes of Patients with Proximal Lower Extremity Deep Vein Thrombosis

Behnood Bikdeli; Babak Sharif-Kashani; Bavand Bikdeli; Reina Valle; Conxita Falga; Antoni Riera-Mestre; Lucia Mazzolai; Peter Verhamme; Philip S. Wells; Juan Francisco Sánchez Muñoz Torrero; Luciano Lopez-Jiménez; Manuel Monreal; For the RIETE Investigators

doi:10.1055/s-0037-1621716

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2018; 44(04): 341-347
DOI: 10.1055/s-0037-1621716

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Thrombus Sidedness on Presentation and Outcomes of Patients with Proximal Lower Extremity Deep Vein Thrombosis

Behnood Bikdeli

¹Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York-Presbyterian Hospital, New York, New York

²Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, Connecticut

¹⁵Cardiovascular Research Foundation, New York, New York

,

Babak Sharif-Kashani

³Division of Cardiology, Masih-Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

,

Bavand Bikdeli

⁴Aged and Extended Care Services, The Queen Elizabeth Hospital, Adelaide, Australia

⁵School of Medicine, University of Adelaide, Adelaide, Australia

,

Reina Valle

⁶Department of Internal Medicine, Hospital Sierrallana, Santander, Spain

,

Conxita Falga

⁷Department of Internal Medicine, Consorci Hospitalari de Mataró, Barcelona, Spain

,

Antoni Riera-Mestre

⁸Department of Internal Medicine, Hospital Universitarie de Bellvitge - IDIBELL and Universitat de Barcelona, Barcelona, Spain

,

Lucia Mazzolai

⁹Division of Angiology, Department of Heart and Vessel, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland

,

Peter Verhamme

¹⁰Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium

,

Philip S. Wells

¹¹Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

,

Juan Francisco Sánchez Muñoz Torrero

¹²Department of Internal Medicine, Hospital Universitario San Pedro de Alcantara, Cáceres, Spain

,

Luciano Lopez-Jiménez

¹³Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain

,

Manuel Monreal

¹⁴Department of Internal Medicine, Universidad Católica de Murcia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

,

For the RIETE Investigators

› Author Affiliations

Abstract

Small studies have suggested differences in demographics and outcomes between left- and right-sided deep vein thrombosis (DVT), and also unilateral versus bilateral DVT. We investigated the clinical presentation and outcomes of patients with DVT based on thrombus sidedness. The authors used the data from the Registro Informatizado Enfermedad TromboEmbólica (RIETE) database (2001–2016) to identify patients with symptomatic proximal lower-extremity DVT. Main outcomes included cumulative 90-day symptomatic pulmonary embolism (PE) and 1-year mortality. Overall, 30,445 patients were included. The majority of DVTs occurred in the left leg (16,421 left-sided, 12,643 right-sided, and 1,390 bilateral; p < 0.001 for chi-squared test comparing all three groups). Comorbidities were relatively similar in those with left-sided and right-sided DVT. Compared with those with left-sided DVT, patients with right-sided DVT had higher relative frequency of PE (26% versus 23%, p < 0.001) and 1-year mortality (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.00–1.18). This difference in mortality did not persist after multivariable adjustment (OR: 1.01; 95% CI: 0.93–1.1). Patients with bilateral DVT had a greater burden of comorbidities such as heart failure, and recent surgery compared with those with unilateral DVT (p < 0.001), and higher relative frequency of PE (48%), and 1-year mortality (24.1%). Worse outcomes in patients with bilateral DVT were attenuated but persisted after multivariable adjustment for demographics and risk factors (OR: 1.64; 95% CI: 1.43–1.87). Patients with bilateral DVT had worse outcomes during and after discontinuation of anticoagulation. There is a left-sided preponderance for proximal lower-extremity DVT. Compared with those with left-sided DVT, patients with right-sided DVT have slightly higher rates of PE. Bilateral DVT is associated with markedly worse short-term and 1-year outcomes.

Keywords

deep vein thrombosis - right - left - bilateral - pulmonary embolism

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References

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