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CC BY 4.0 · Thromb Haemost 2023; 123(08): 763-772
DOI: 10.1055/a-2059-4737
Coagulation and Fibrinolysis

Residual Venous Obstruction as an Indicator of Clinical Outcomes following Deep Vein Thrombosis: A Management Study

Aaron F. J. Iding 
1   Thrombosis Expertise Center, Heart + Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
2   Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
,
Bram M. M. Kremers
2   Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
,
Alejandro Pallares Robles
2   Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
3   Center of Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
,
Hugo ten Cate 
1   Thrombosis Expertise Center, Heart + Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
2   Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
3   Center of Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
4   Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
,
Arina J. ten Cate-Hoek
1   Thrombosis Expertise Center, Heart + Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
2   Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
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Abstract

Background Residual venous obstruction (RVO) is considered a risk factor of recurrence and possibly other clinical outcomes following deep vein thrombosis (DVT). Current guidelines do not support an RVO-tailored duration of anticoagulant therapy; contemporary data of such management strategies are scarce. We aimed to evaluate an RVO-based management strategy and to assess associations of RVO with recurrence, post-thrombotic syndrome (PTS), arterial events and cancer. To gain further insight, D-dimer levels were measured 1 month after stopping anticoagulant therapy.

Methods Consecutive patients with symptomatic, proximal DVT were treated in a 2-year clinical care pathway (CCP) at Maastricht University Medical Center and were followed up to 5 years. RVO was assessed at the end of regular duration of anticoagulant therapy, which was extended once if RVO was detected. The study was approved by the medical ethics committee.

Result From a total of 825 patients, 804 patients (97.5%) completed the CCP and 755 (93.9%) were available for extended follow-up. Most patients (76.5%) stopped anticoagulant therapy. Incidence rates of recurrence, PTS, arterial events, and cancer were 4.4, 11.9, 1.7, and 1.8 per 100 patient-years, respectively. RVO was independently associated with PTS (hazard ratio [HR]: 1.66 [1.19–2.32]) and arterial events (HR: 2.07 [1.18–3.65]), but not with recurrence or cancer. High D-dimer was associated with recurrence (HR: 3.51 [2.24–5.48]).

Conclusion Our RVO-based management strategy might have attenuated the association of RVO with recurrence. In addition, RVO identified patients at increased risk of PTS and arterial events, which might be used to identify patients in need of alternative treatment strategies.

Keywords

cancer - deep vein thrombosis - post-thrombotic syndrome - residual venous obstruction - venous thromboembolism

Authors' Contribution

A.J.T.C-H. implemented the CCP. A.J.T.C-H. and B.M.M.K. collected the data. A.F.J.I. and A.P.R. drafted the analysis plan and conducted the statistical analysis under supervision of A.J.T.C-H. A.F.J.I. drafted the article. A.F.J.I., A.J.T.C-H., B.M.M.K., A.P.R., and H.T.C. critically revised the article. A.J.T.C-H. gave final approval of the version to be published.


Supplementary Material



Publication History

Received: 09 September 2022

Accepted: 14 March 2023

Accepted Manuscript online:
21 March 2023

Article published online:
12 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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