Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis

Andrei Brateanu; Krishna Patel; Kevin Chagin; Pichapong Tunsupon; Pojchawan Yampikulsakul; Gautam V. Shah; Sintawat Wangsiricharoen; Linda Amah; Joshua Allen; Aryeh Shapiro; Neha Gupta; Lillie Morgan; Rahul Kumar; Craig Nielsen; Michael B. Rothberg

doi:10.1160/th15-06-0503

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(03): 608-614
DOI: 10.1160/th15-06-0503

Coagulation and Fibrinolysis

Schattauer GmbH

Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis

Andrei Brateanu

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Krishna Patel

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Kevin Chagin

²Quantitative Health Sciences, Cleveland Clinic, Cleveland Clinic, Cleveland, Ohio, USA

,

Pichapong Tunsupon

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Pojchawan Yampikulsakul

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Gautam V. Shah

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Sintawat Wangsiricharoen

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Linda Amah

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Joshua Allen

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Aryeh Shapiro

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Neha Gupta

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Lillie Morgan

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Rahul Kumar

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Craig Nielsen

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

,

Michael B. Rothberg

¹Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

› Author Affiliations

Abstract

Summary

Isolated distal deep-vein thrombosis (DDVT) of the lower extremities can be associated with subsequent proximal deep-vein thrombosis (PDVT) and/or acute pulmonary embolism (PE). We aimed to develop a model predicting the probability of developing PDVT and/or PE within three months after an isolated episode of DDVT. We conducted a retrospective cohort study of patients with symptomatic DDVT confirmed by lower extremity vein ultrasounds between 2001–2012 in the Cleveland Clinic Health System. We reviewed all the ultrasounds, chest ventilation/perfusion and computed tomography scans ordered within three months after the initial DDVT to determine the incidence of PDVT and/or PE. A multiple logistic regression model was built to predict the rate of developing these complications. The final model included 450 patients with isolated DDVT. Within three months, 30 (7%) patients developed an episode of PDVT and/or PE. Only two factors predicted subsequent thromboembolic complications: inpatient status (OR, 6.38; 95 % CI, 2.17 to 18.78) and age (OR, 1.02 per year; 95 % CI, 0.99 to 1.05). The final model had a bootstrap bias-corrected c-statistic of 0.72 with a 95 % CI (0.64 to 0.79). Outpatients were at low risk (<4 %) of developing PDVT/PE. Inpatients aged ≥ 60 years were at high risk (> 10%). Inpatients aged < 60 were at intermediate risk. We created a simple model that can be used to risk stratify patients with isolated DDVT based on inpatient status and age. The model might be used to choose between anticoagulation and monitoring with serial ultrasounds.

Keywords

Deep-vein thrombosis - distal deep-vein thrombosis - proximal deepvein thrombosis - pulmonary embolism

Full Text

References

References
1 De Martino RR, Wallaert JB, Rossi AP. et al. A meta-analysis of anticoagulation for calf deep venous thrombosis. J Vasc Surg 2012; 56: 228-237 e1.
2 Kearon C, Akl EA, Comerota AJ. et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e419S-94S.
3 Ciuti G, Grifoni E, Pavellini A. et al. Incidence and characteristics of asymptomatic distal deep vein thrombosis unexpectedly found at admission in an Internal Medicine setting. Thromb Res 2012; 130: 591-595.
4 Anderson Jr. FA, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107 (23) (Suppl. 01) I9-16.
5 Harrell FE. Regression modeling strategies: With applications to linear models, logistic regression, and survival analysis. 45. New York: Springer; 2001: 1-67.
6 Palareti G, Schellong S. Isolated distal deep vein thrombosis: what we know and what we are doing. J Thromb Haemost 2012; 10: 11-19.
7 Galanaud JP, Quenet S, Rivron-Guillot K. et al. Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients. J Thromb Haemost 2009; 7: 2028-2034.
8 Baglin T, Douketis J, Tosetto A. et al. Does the clinical presentation and extent of venous thrombosis predict likelihood and type of recurrence? A patient-level meta-analysis. J Thromb Haemost 2010; 8: 2436-2442.
9 Galanaud JP, Sevestre-Pietri MA, Bosson JL. et al. 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.
10 Galanaud JP, Sevestre MA, Genty C. et al. Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost 2014; 12: 436-443.
11 Fahrni J, Husmann M, Gretener SB. et al. Assessing the risk of recurrent venous thromboembolism - a practical approach. Vasc Health Risk Manag 2015; 11: 451-459.
12 Sales CM, Haq F, Bustami R. et al. Management of isolated soleal and gastrocne-mius vein thrombosis. J Vasc Surg 2010; 52: 1251-1254.
13 Schwarz T, Buschmann L, Beyer J. et al. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg 2010; 52: 1246-1250.