PDF herunterladen
Thromb Haemost 2011; 105(01): 31-39
DOI: 10.1160/TH10-06-0406
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Predictive factors for concurrent deep-vein thrombosis and symptomatic venous thromboembolic recurrence in case of superficial venous thrombosis

The OPTIMEV study
Jean-Philippe Galanaud
1   Vascular medicine unit, Department of internal medicine, University Hospital, Montpellier, France
2   Research Unit EA2992, Montpellier 1 University, Montpellier, France
,
Celine Genty
3   Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique (CNRS), Université Joseph Fourier, Grenoble, France
4   Clinical Investigation Center, University Hospital, Grenoble, France
,
Marie-Antoinette Sevestre
3   Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique (CNRS), Université Joseph Fourier, Grenoble, France
4   Clinical Investigation Center, University Hospital, Grenoble, France
5   Vascular medicine Unit, Amiens University Hospital, Amiens, France
,
Dominique Brisot
1   Vascular medicine unit, Department of internal medicine, University Hospital, Montpellier, France
6   Vascular medicine physician, Clapiers, France
,
Michel Lausecker
7   Vascular medicine physician, Selestat, France
,
Jean-Luc Gillet
8   Vascular medicine physician, Bourgoin-Jallieu, France
,
Carole Rolland
3   Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique (CNRS), Université Joseph Fourier, Grenoble, France
4   Clinical Investigation Center, University Hospital, Grenoble, France
,
Marc Righini
9   Division of Angiology and Haemostasis, Geneva University Hospital, Geneva, Switzerland
,
Georges Leftheriotis
10   Vascular Medicine Unit, University Hospital, Angers, France
,
Jean-Luc Bosson
3   Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique (CNRS), Université Joseph Fourier, Grenoble, France
4   Clinical Investigation Center, University Hospital, Grenoble, France
,
Isabelle Quere
1   Vascular medicine unit, Department of internal medicine, University Hospital, Montpellier, France
2   Research Unit EA2992, Montpellier 1 University, Montpellier, France
,
the OPTIMEV SFMV investigators › Institutsangaben Financial support: The study was funded by a grant from the Hospital Clinical Research Program of the French Ministry of Health and a grant from Sanofi-Aventis. This study was supported by the French Society of Vascular Medicine (SFMV). All investigators are members of the SFMV.
Weitere Informationen

Publikationsverlauf

Received: 25. Juni 2010

Accepted after minor revision: 10. September 2010

Publikationsdatum:
22. November 2017 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Summary

Superficial venous thrombosis (SVT) prognosis is debated and its management is highly variable. It was the objective of this study to assess predictive risk factors for concurrent deep-vein thrombosis (DVT) at presentation and for three-month adverse outcome. Using data from the prospective multicentre OPTIMEV study, we analysed SVT predictive factors associated with concurrent DVT and three-month adverse outcome. Out of 788 SVT included, 227 (28.8%) exhibited a concurrent DVT at presentation. Age >75years (odds ratio [OR]=2.9 [1.5–5.9]), active cancer (OR=2.6 [1.3–5.2]), inpatient status (OR=2.3 [1.2–4.4]) and SVT on non-varicose veins (OR=1.8 [1.1–2.7]) were significantly and independently associated with an increased risk of concurrent DVT. 39.4% of SVT on non-varicose veins presented a concurrent DVT. However, varicose vein status did not influence the three-month prognosis as rates of death, symptomatic venous thromboembolic (VTE) recurrence and major bleeding were equivalent in both non-varicose and varicose SVTs (1.4% vs. 1.1%; 3.4% vs. 2.8%; 0.7% vs. 0.3%). Only male gender (OR=3.5 [1.1–11.3]) and inpatient status (OR=4.5 [1.3–15.3]) were independent predictive factors for symptomatic VTE recurrence but the number of events was low (n=15, 3.0%). Three-month numbers of deaths (n=6, 1.2%) and of major bleedings (n=2, 0.4%) were even lower, precluding any relevant interpretation. In conclusion, SVT on non-varicose veins and some classical risk factors for DVT were predictive factors for concurrent DVT at presentation. As SVT remains mostly a clinical diagnosis, these data may help selecting patients deserving an ultrasound examination or needing anticoagulation while waiting for diagnostic tests. Larger studies are needed to evaluate predictive factors for adverse outcome.

Keywords

Superficial vein thrombosis - thrombophlebitis - deep-vein thrombosis - pulmonary embolism - varicose veins

* A list of the OPTIMEV SMFV Study investigators is available online at www.thrombosis-online.com.


 

  • References

  • 1 Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2007; 02: CD004982.
    PubMedGoogle Scholar
  • 2 Di Minno G, Mannucci PM, Tufano A. et al. First Ambulatory Screening On Thromboembolism (fast) Study Group. The first ambulatory screening on thromboembolism: a multicentre, cross-sectional, observational study on risk factors for venous thromboembolism. J Thromb Haemost 2005; 03: 1459-1466.
    CrossrefPubMedGoogle Scholar
  • 3 Decousus H, Leizorovicz A. Superficial thrombophlebitis of the legs: still a lot to learn. J Thromb Haemost 2005; 03: 1149-1151.
    CrossrefPubMedGoogle Scholar
  • 4 Leon L, Giannoukas AD, Dodd D. et al. Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg 2005; 29: 10-17.
    CrossrefPubMedGoogle Scholar
  • 5 Bounameaux H, Righini M, Gal GL. Superficial thrombophlebitis of the legs: still a lot to learn. A rebuttal. J Thromb Haemost 2006; 04: 289.
    CrossrefPubMedGoogle Scholar
  • 6 Kearon C, Kahn SR, Agnelli G. et al. American College of Chest Physicians. Anti-thrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 454S-545S.
    CrossrefPubMedGoogle Scholar
  • 7 Superficial Thrombophlebitis Treated By Enoxaparin Study Group.. A pilot randomized double-blind comparison of a low-molecular-weight heparin, a nonsteroidal anti-inflammatory agent, and placebo in the treatment of superficial vein thrombosis. Arch Intern Med 2003; 163: 1657-1663.
    CrossrefPubMedGoogle Scholar
  • 8 Prandoni P, Tormene D, Pesavento R. Vesalio Investigators Group. High vs. low doses of low-molecular-weight heparin for the treatment of superficial vein thrombosis of the legs: a double-blind, randomized trial. J Thromb Haemost 2005; 03: 1152-1157.
    CrossrefPubMedGoogle Scholar
  • 9 Decousus H, Quéré I, Presles E. et al, for the POST study group. Superficial vein thrombosis and venous thromboembolism: a large prospective epidemiological study. Ann Int Med 2010; 152: 218-224.
    CrossrefPubMedGoogle Scholar
  • 10 Decousus H, Prandoni P, Mismetti P. et al for the Calisto study group. Fondaparinux in the treatment of lower limb superficial-vein thrombosis. N Engl J Med 2010; 363: 1222-1232.
    CrossrefPubMedGoogle Scholar
  • 11 Bergqvist D, Jaroszewski H. Deep vein thrombosis in patients with superficial thrombophlebitis of the leg. Br Med J (Clin Res Ed) 1986; 292: 658-659.
    PubMedGoogle Scholar
  • 12 Binder B, Lackner HK, Salmhofer W. et al. Association between superficial vein thrombosis and deep vein thrombosis of the lower extremities. Arch Dermatol 2009; 145: 753-757.
    CrossrefPubMedGoogle Scholar
  • 13 Sevestre MA, Labarère J, Casez P. et al. Outcomes for Inpatients with Normal Findings on Whole-Leg Ultrasonography. A Multicenter Prospective Cohort Study. Am J Med 2010; 123: 158-165.
    CrossrefPubMedGoogle Scholar
  • 14 Galanaud JP, Sevestre MA, Bosson JL. et al, and the Optimev SFMV investigators. Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep-vein thrombosis: Results from the OPTIMEV study. Thromb Haemost 2009; 102: 493-500.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 15 Stein PD, Fowler SE, Goodman LR. et al, PIOPED II Investigators. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354: 2317-2327.
    CrossrefPubMedGoogle Scholar
  • 16 The PIOPED Investigators.. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). J Am Med Assoc 1990; 263: 2753-2759.
    CrossrefPubMedGoogle Scholar
  • 17 Eklöf B, Rutherford RB, Bergan JJ. et al. American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40: 1248-1252.
    CrossrefPubMedGoogle Scholar
  • 18 Gillet JL, Allaert FA, Perrin M. Superficial thrombophlebitis in non-varicose veins of the lower limbs. A prospective analysis in 42 patients. J Mal Vasc 2004; 29: 263-272.
    CrossrefPubMedGoogle Scholar
  • 19 Gorty S, Patton-Adkins J, DaLanno M. et al. Superficial venous thrombosis of the lower extremities: analysis of risk factors, and recurrence and role of anticoagulation. Vasc Med 2004; 09: 1-6.
    CrossrefPubMedGoogle Scholar
  • 20 Quenet S, Laporte S, Décousus H. et al. STENOX Group. Factors predictive of venous thrombotic complications in patients with isolated superficial vein thrombosis. J Vasc Surg. 2003; 38: 944-949.
    CrossrefPubMedGoogle Scholar
  • 21 Meissner MH, Gloviczki P, Bergan J. et al. Primary chronic venous disorders. J Vasc Surg 2007; 46: 54S-67S.
    CrossrefPubMedGoogle Scholar
  • 22 Galanaud JP, Quenet S, Rivron-Guillot K. et al. Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis versus proximal deep-vein thrombosis in 11086 patients (RIETE registry). J Thromb Haemost 2009; 07: 2028-2034.
    CrossrefPubMedGoogle Scholar
  • 23 Sevestre MA, Quashié C, Genty C. et al. for the Optimev study investigators. Clinical presentation and mortality in pulmonary embolism: the Optimev Study. J Mal Vasc 2010; 35: 242-249.
    CrossrefPubMedGoogle Scholar