Prognostic significance of residual venous obstruction in patients with treated unprovoked deep vein thrombosis

Marco P. Donadini; Walter Ageno; Emilia Antonucci; Benilde Cosmi; Michael J. Kovacs; Grégoire Le Gal; Paul Ockelford; Daniela Poli; Paolo Prandoni; Marc Rodger; Giorgia Saccullo; Sergio Siragusa; Laura Young; Matteo Bonzini; Monica Caprioli; Francesco Dentali; Alfonso Iorio; James D. Douketis

doi:10.1160/TH13-04-0336

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2014; 111(01): 172-179
DOI: 10.1160/TH13-04-0336

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Prognostic significance of residual venous obstruction in patients with treated unprovoked deep vein thrombosis

A patient-level meta-analysis

Marco P. Donadini

¹Department of Clinical and Experimental Medicine, Thrombosis Center, University of Insubria, Varese, Italy

,

Walter Ageno

¹Department of Clinical and Experimental Medicine, Thrombosis Center, University of Insubria, Varese, Italy

,

Emilia Antonucci

²Department of Medical-Surgical Critical Area, Thrombosis Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

Benilde Cosmi

³3Department of Angiology and Blood Coagulation “Marino Golinelli”, University Hospital S. Orsola-Malpighi, Bologna, Italy

,

Michael J. Kovacs

⁴Department of Hematology, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada

,

Grégoire Le Gal

⁵Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France

,

Paul Ockelford

⁶Department of Haematology, Auckland City Hospital, Auckland, New Zealand

,

Daniela Poli

²Department of Medical-Surgical Critical Area, Thrombosis Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

Paolo Prandoni

⁷Department of Cardiothoracic and Vascular Sciences, Second Division of Internal Medicine, Thromboembolism Unit, University of Padua, Italy

,

Marc Rodger

⁸Department of Medicine, Division of Hematology, Thrombosis Program, University of Ottawa, Ontario, Canada

,

Giorgia Saccullo

⁹Department of Internal Medicine, Cardiovascular and Nephrourologic Diseases, Hematology Unit, University of Palermo, Italy

,

Sergio Siragusa

⁹Department of Internal Medicine, Cardiovascular and Nephrourologic Diseases, Hematology Unit, University of Palermo, Italy

,

Laura Young

¹⁰Department of Molecular Medicine and Pathology, University of Auckland, New Zealand

,

Matteo Bonzini

¹¹Department of Clinical and Experimental Medicine, Epidemiology and Preventive Medicine Research Centre, University of Insubria, Varese, Italy

,

Monica Caprioli

¹Department of Clinical and Experimental Medicine, Thrombosis Center, University of Insubria, Varese, Italy

,

Francesco Dentali

¹Department of Clinical and Experimental Medicine, Thrombosis Center, University of Insubria, Varese, Italy

,

Alfonso Iorio

¹²Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

,

James D. Douketis

¹³Department of Medicine, McMaster University, Hamilton, Ontario, Canada

› Author Affiliations

Abstract

Summary

Residual venous obstruction (RVO) could improve the stratification of the risk of recurrence after unprovoked deep vein thrombosis (DVT), but results from clinical studies and study-level meta-analyses are conflicting. It was the objective of this analysis to determine if RVO is a valid predictor of recurrent venous thromboembolism (VTE) in patients with a first unprovoked DVT who had received at least three months of anticoagulant therapy. Individual patient data were obtained from the datasets of original studies, after a systematic search of electronic databases (Medline, Embase, Cochrane Library), supplemented by manual reviewing of the reference lists and contacting content experts. A multivariate, shared-frailty Cox model was used to calculate hazard ratios (HRs) for recurrent VTE, including, as covariates: RVO; age; sex; anticoagulation duration before RVO assessment; and anticoagulation continuation after RVO assessment. A total of 2,527 patients from 10 prospective studies were included. RVO was found in 1,380 patients (55.1%) after a median of six months from a first unprovoked DVT. Recurrent VTE occurred in 399 patients (15.8%) during a median follow-up of 23.3 months. After multivariate Cox analysis, RVO was independently associated with recurrent VTE (HR = 1.32, 95% confidence interval [CI]: 1.06–1.65). The association was stronger if RVO was detected early, i.e. at three months after DVT (HR = 2.17; 95% CI: 1.11–4.25), but non-significant if detected later, i.e. >6 months (HR = 1.19; 95% CI: 0.87–1.61). In conclusion, after a first unprovoked DVT, RVO is a weak overall predictor of recurrent VTE. The association is stronger if RVO is detected at an earlier time (3 months) after thrombosis.

Keywords

Residual venous obstruction - patient-level meta-analysis - unprovoked deep vein thrombosis - recurrent venous thromboembolism

Full Text

References

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