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Thromb Haemost 2021; 121(12): 1650-1659
DOI: 10.1055/a-1414-5055
Stroke, Systemic or Venous Thromboembolism

Prognostic Significance of Concomitant Superficial Vein Thrombosis in Patients with Deep Vein Thrombosis of the Lower Limbs

Álvaro Dubois-Silva 
1   Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, Spain
2   Universidade da Coruña, A Coruña, Spain
,
Cristina Barbagelata-López
1   Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, Spain
,
Patricia Piñeiro-Parga
1   Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, Spain
,
Iria Francisco
3   Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, Spain
,
Conxita Falgá
4   Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
,
Raimundo Tirado
5   Department of Internal Medicine, Hospital Infanta Margarita, Córdoba, Spain
,
José María Suriñach
6   Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
,
Jerónimo Ramón Vela
7   Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
,
Carmen Mella
8   Department of Internal Medicine, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
,
Isabelle Quere
9   Department of Vascular Medicine, Hôpital Saint Eloi, Montpellier, France
,
Carmine Siniscalchi
10   Department of Angiology, Azienda Ospedaliera Universitaria, Parma, Italy
,
Manuel Monreal
11   Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Universidad Autónoma de Barcelona, Spain
,
the RIETE Investigators › Author Affiliations
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Abstract

Background The prognostic significance of concomitant superficial vein thrombosis (SVT) in patients with lower-limb deep vein thrombosis (DVT) has not been consistently evaluated.

Methods We used the RIETE (Registro Informatizado de Enfermedad TromboEmbólica) registry to compare the rates of subsequent pulmonary embolism (PE), recurrent DVT, major bleeding or death in patients with lower-limb DVT, according to the presence or absence of concomitant SVT.

Results From March 2015 to May 2020, there were 8,743 patients with lower-limb DVT. Of these, 745 (8.5%) had concomitant SVT. Most patients (97.4% in both subgroups) received anticoagulant therapy (median duration: 138 vs. 147 days). During follow-up (median: 193 vs. 210 days), 156 (1.8%) patients developed subsequent PE, 336 (3.8%) had recurrent DVT, 201 (2.3%) had major bleeding and 844 (9.7%) died. Patients with concomitant SVT had a higher rate of subsequent PE (rate ratio [RR]: 2.11; 95% confidence interval [95%CI]: 1.33–3.24) than those with isolated DVT, with no significant differences in the rates of recurrent DVT (RR: 0.80; 95%CI: 0.50–1.21), major bleeding (RR: 0.77; 95%CI: 0.41–1.33) or death (RR: 0.81; 95%CI: 0.61–1.06). On multivariable analysis, patients with DVT and SVT concomitantly were at increased risk of subsequent PE during anticoagulation (adjusted hazard ratio [HR]: 2.23; 95%CI: 1.22–4.05) and also during the entire follow-up period (adjusted HR: 2.33; 95%CI: 1.49–3.66).

Conclusion Patients with lower-limb DVT and SVT concomitantly are at increased risk of developing PE. Further studies are needed to externally validate our findings and to determine if these patients could benefit from a different management strategy.

Keywords

anticoagulants - deep vein thrombosis - pulmonary embolism - recurrences - superficial vein thrombosis

Author Contributions

A.D.-S. and M.M. conceived the study idea, collected the data, analyzed the data, wrote the manuscript and approved the final version of the manuscript. C.B.-L., P.P.-P., I.F., C.F., R.T., J.M.S., J.R.V., C.M., I.Q. and C.S. collected the data, analyzed the data, reviewed and contributed to the manuscript and approved the final version of the manuscript. All authors had full access to the data and take responsibility for the integrity of the data and accuracy of the analysis. The corresponding author attests that all listed authors meet authorship criteria. A.D.-S. is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article.


* A full list of the RIETE investigators is given in the [Supplementary Appendix A].


Supplementary Material



Publication History

Received: 23 December 2020

Accepted: 02 March 2021

Accepted Manuscript online:
07 March 2021

Article published online:
30 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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