Recurrence Risk after First Symptomatic Distal versus Proximal Deep Vein Thrombosis According to Baseline Risk FactorsFunding The work of A.T., L.V., S.H.M., S.V.K., and S.B. has been supported by the German Federal Ministry of Education and Research (BMBF 01EO1003 and 01EO1503).
26 November 2018
30 January 2019
11 March 2019 (online)
Background It remains unclear whether the distal location of deep vein thrombosis (DVT) is independently associated with a lower risk of recurrence in all patients, or represents a marker of the presence and severity of provoking factors for venous thromboembolism (VTE).
Methods We investigated the impact of distal (vs. proximal) DVT location on the risk of developing symptomatic, objectively confirmed recurrent VTE in 831 patients with a first acute symptomatic DVT not associated with pulmonary embolism (PE), who were stratified by the presence of transient or persistent risk factors at baseline. The primary outcome was symptomatic, objectively diagnosed recurrent VTE, including proximal DVT and PE.
Results A total of 205 (24.7%) patients presented with a transient risk factor, 189 (22.7%) with a minor persistent risk factor, 202 (24.3%) with unprovoked DVT, and 235 (28.3%) with cancer-associated DVT. One-hundred twenty-five patients (15.0%) experienced recurrent DVT or PE. The largest relative difference between patients with distal (vs. proximal) DVT was observed in the absence of identifiable risk factors (adjusted hazard ratio [aHR]: 0.11; 95% CI [confidence interval]: 0.03–0.45). In patients with cancer, distal and proximal DVT had a comparable risk of recurrence (aHR: 0.70; 95% CI: 0.28–1.78]).
Conclusions The distal (vs. proximal) location of first acute symptomatic DVT represented, in the absence of any identifiable transient or persistent risk factors, a favorable prognostic factor for recurrence. In contrast, the prognostic impact of DVT location was weaker if persistent provoking risk factors for VTE were present, notably cancer.
• L.V.: design of the study, statistical analysis, writing of the manuscript, final approval.
• C.A.: clinical follow-up of patients, adjudication of recurrent events, interpretation of the results, critical revision of the manuscript, final approval.
• M.C. and A.C.: collection of data, interpretation of the results, critical revision of the manuscript, final approval.
• M.B. and C.P.: clinical follow-up of patients, collection of data, interpretation of the results, critical revision of the manuscript, final approval.
• S.V.K., S.H.M., and C.P.: interpretation of the results, critical revision of the manuscript, final approval.
• S.B.: concept and design of the study, clinical follow-up of patients, collection of data, adjudication of recurrent events, statistical analysis, interpretation of the results, writing of the manuscript, final approval.
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