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
1   Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York-Presbyterian Hospital, New York, New York
2   Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, Connecticut
15   Cardiovascular Research Foundation, New York, New York
Babak Sharif-Kashani
3   Division of Cardiology, Masih-Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Bavand Bikdeli
4   Aged and Extended Care Services, The Queen Elizabeth Hospital, Adelaide, Australia
5   School of Medicine, University of Adelaide, Adelaide, Australia
Reina Valle
6   Department of Internal Medicine, Hospital Sierrallana, Santander, Spain
Conxita Falga
7   Department of Internal Medicine, Consorci Hospitalari de Mataró, Barcelona, Spain
Antoni Riera-Mestre
8   Department of Internal Medicine, Hospital Universitarie de Bellvitge - IDIBELL and Universitat de Barcelona, Barcelona, Spain
Lucia Mazzolai
9   Division of Angiology, Department of Heart and Vessel, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
Peter Verhamme
10   Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
Philip S. Wells
11   Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Juan Francisco Sánchez Muñoz Torrero
12   Department of Internal Medicine, Hospital Universitario San Pedro de Alcantara, Cáceres, Spain
Luciano Lopez-Jiménez
13   Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Manuel Monreal
14   Department of Internal Medicine, Universidad Católica de Murcia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
For the RIETE Investigators › Author Affiliations
Funding RIETE registry is supported by research grants from Sanofi-Aventis and Bayer Pharma. The funders have no access to the database. No specific funding was sought for this manuscript. The funders had no role in study design, analyses, preparation of the manuscript, or decision to submit.
Further Information

Publication History

Publication Date:
12 January 2018 (online)


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.

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