Long-Term Clinical Course of Proximal Deep Venous Thrombosis and Detection of Recurrent Thrombosis

ABSTRACT

Symptomatic proximal deep vein thrombosis of lower extremities carries a high risk for recurrent venous thromboembolism that persists for many years. This risk is dependent on readily identifiable risk factors, being low after a trauma or a surgical intervention and higher in all the other patient categories. Moreover, postthrombotic sequelae will develop in one of every three patients, this risk being strongly related to the development of ipsilateral thrombosis. Although the optimal duration of anticoagulation in patients who experience an episode of proximal vein thrombosis is unknown, it seems reasonable to administer a short-term course of coumarin drugs to patients with thrombosis associated with transient risk factors, whereas a longer course (6 to 12 months) should be considered in patients with idiopathic thrombosis and in those with permanent risk factors. Indefinite anticoagulant therapy is a clinical judgement in the individual patient. The management of patients who develop clinical manifestations suggestive of recurrent ipsilateral venous thrombosis still represents a challenge for clinicians. Recent data suggest that these patients can be safely managed with the use of serial compression ultrasonography.

KEYWORD

Deep vein thrombosis - postthrombotic syndrome - oral anticoagulants - elastic stockings - compression ultrasonography

REFERENCES

• 1 Lensing A WA, Prandoni P, Prins H R, Büller H R. Deep-vein thrombosis.  Lancet . 1999;  353 479-485
• 2 Ginsberg J S. Management of venous thromboembolism.  N Engl J Med . 1996;  335 1816-1828
• 3 Bergqvist D, Jendteg S, Johansen L, Persson U, Ödegaard K. Cost of long-term complications of deep venous thrombosis of the lower extremities: An analysis of a defined patient population in Sweden.  Ann Intern Med . 1997;  126 454-457
• 4 Prandoni P, Lensing A WA, Cogo A. The long-term clinical course of acute deep venous thrombosis.  Ann Intern Med . 1996;  125 1-7
• 5 Franzeck U K, Schalch I, Jager K A. Prospective 12-year follow-up of clinical and hemodynamic sequelae after deep vein thrombosis in low-risk patients (Zürich Study).  Circulation . 1996;  93 74-79
• 6 Schulman S, Rhedin A S, Lindmarker P. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism.  N Engl J Med . 1995;  332 1661-1665
• 7 Immelman E J, Jeffery P C. The postphlebitic syndrome. Pathophysiology, prevention and management.  Clin Chest Med . 1984;  5 537-550
• 8 Bauer G A. Roentgenological and clinical study of the sequels of thrombosis.  Acta Chir Scand . 1942;  (suppl 74) 1-110
• 9 Gjores J. The incidence of venous thrombosis and its sequelae in certain districts of Sweden.  Acta Chir Scand . 1956;  1-88 (1-88)
• 10 O'Donnell F F, Browse N L, Burnand K G, Lea Thomas M. The socioeconomic effects of an ilio-femoral venous thrombosis.  J Surg Res . 1977;  22 483-488
• 11 Strandness D E, Langlois Y, Cramer M, Randlett A, Thiele B L. Long-term sequelae of acute venous thrombosis.  JAMA . 1983;  250 1289-1292
• 12 Widmer L K, Zemp E, Widmer M TH. Late results in deep-vein thrombosis of the lower extremities.  Vasa . 1985;  14 264-268
• 13 Lindner D J, Edwards J M, Phinney E S, Taylor L M, Porter J M. Long-term hemodynamic and clinical sequelae of lower extremity deep-vein thrombosis.  J Vasc Surg . 1986;  4 436-442
• 14 Heldal M, Seem E, Snadset P M, Abildgaard U. Deep-vein thrombosis: a 7-year follow-up study.  J Intern Med . 1993;  234 71-75
• 15 Monreal M, Martorell A, Callejas J M. Venographic assessment of deep-vein thrombosis and risk of developing post-thrombotic syndrome: A prospective study.  J Intern Med . 1993;  233 854-859
• 16 Milne A A, Ruckley C V. The clinical course of patients following extensive deep venous thrombosis.  Eur J Vasc Surg . 1994;  8 56-59
• 17 Saarinen J, Sisto T, Laurikka J, Salenius J P, Tarkka M. Late sequelae of acute deep venous thrombosis: Evaluatioan five and ten years after.  Phlebology . 1995;  10 106-109
• 18 Beyth R J, Cohen A M, Landefeld S. Long-term outcomes of deep-vein thrombosis.  Arch Intern Med . 1995;  155 1031-1037
• 19 Brandjes D PM, Büller H R, Heijboer H. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis.  Lancet . 1997;  349 759-762
• 20 Hull R, Raskob G E, Hirsh J, Sackett D L. A cost-effectiveness analysis of alternative approaches for long-term treatment of proximal venous thrombosis.  JAMA . 1984;  252 235-239
• 21 Lopaciuk S, Bielska-Falda H, Noszczyk W. Low molecular weight heparin versus acenocoumarol in the secondary prophylaxis of deep vein thrombosis.  Thromb Haemost . 1999;  81 26-31
• 22 Monreal M, Lafoz E, Olive A, del Rio L, Vedia C. Comparison of subcutaneous unfractionated heparin with a low molecular weight heparin (Fragmin) in patients with venous thromboembolism and contraindications to coumarin.  Thromb Haemost . 1994;  71 7-11
• 23 Pini M, Aiello S, Manotti C. Low molecular weight heparin versus warfarin in the prevention of recurrences after deep vein thrombosis.  Thromb Haemost . 1994;  72 191-197
• 24 Kearon C, Gent M, Hirsh J. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism.  N Engl J Med . 1999;  340 901-907
• 25 Schulman S, Granqvist S, Holmstrom M. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism.  N Engl J Med . 1997;  336 393-398
• 26 Levine M N, Raskob G E, Landefeld S, Kearon C. Hemorrhagic complications of anticoagulant treatment.  Chest . 1998;  511-523 (511-523)
• 27 Palareti G, Leali N, Coccheri S. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT).  Lancet . 1996;  348 423-428
• 28 Prandoni P, Lensing A WA, Bagatella P, Simioni P, Girolami A. Low rate of warfarin-related major bleeding in patients with recurrent venous thromboembolism.  Thromb Haemost . 1999;  82 158-159
• 29 Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals.  Circulation . 1996;  93 2212-2245
• 30 Hull R D, Carter C J, Jay R M. The diagnosis of acute recurrent deep-vein thrombosis. A diagnostic challenge.  Circulation . 1983;  67 901-906
• 31 Leclerc J R, Jay R M, Hull R D, Hirsh J. Recurrent leg symptoms following deep vein thrombosis. A diagnostic challenge.  Arch Intern Med . 1985;  145 1867-1869
• 32 Huisman M V, Büller H R, ten Cate W J. Utility of impedance plethysmography in the diagnosis of recurrent deep-vein thrombosis.  Arch Intern Med . 1988;  148 681-683
• 33 Heijboer H, Jongbloets L MM, Büller H R, Lensing A WA, ten Cate W J. Clinical utility of real-time compression ultrasonography for diagnostic management of patients with recurrent venous thrombosis.  Acta Radiol . 1992;  33 297-300
• 34 Prandoni P, Cogo A, Bernardi E. A simple ultrasound approach for detection of recurrent proximal-vein thrombosis.  Circulation . 1993;  88 1730-1735
• 35 Villalta S, Rossi L, Bernardi E. Serial compression ultrasonography in the diagnostic approach of patients with clinically suspected recurrent deep-vein thrombosis. Interim report of an ongoing study (abstract).  Thromb Haemost . 1997;  OC-2401 (OC-2401)