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

Authors

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

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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