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
Marco P. Donadini
1  Department of Clinical and Experimental Medicine, Thrombosis Center, University of Insubria, Varese, Italy
,
Walter Ageno
1  Department of Clinical and Experimental Medicine, Thrombosis Center, University of Insubria, Varese, Italy
,
Emilia Antonucci
2  Department of Medical-Surgical Critical Area, Thrombosis Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
,
Benilde Cosmi
3  3Department of Angiology and Blood Coagulation “Marino Golinelli”, University Hospital S. Orsola-Malpighi, Bologna, Italy
,
Michael J. Kovacs
4  Department of Hematology, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
,
Grégoire Le Gal
5  Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France
,
Paul Ockelford
6  Department of Haematology, Auckland City Hospital, Auckland, New Zealand
,
Daniela Poli
2  Department of Medical-Surgical Critical Area, Thrombosis Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
,
Paolo Prandoni
7  Department of Cardiothoracic and Vascular Sciences, Second Division of Internal Medicine, Thromboembolism Unit, University of Padua, Italy
,
Marc Rodger
8  Department of Medicine, Division of Hematology, Thrombosis Program, University of Ottawa, Ontario, Canada
,
Giorgia Saccullo
9  Department of Internal Medicine, Cardiovascular and Nephrourologic Diseases, Hematology Unit, University of Palermo, Italy
,
Sergio Siragusa
9  Department of Internal Medicine, Cardiovascular and Nephrourologic Diseases, Hematology Unit, University of Palermo, Italy
,
Laura Young
10  Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
,
Matteo Bonzini
11  Department of Clinical and Experimental Medicine, Epidemiology and Preventive Medicine Research Centre, University of Insubria, Varese, Italy
,
Monica Caprioli
1  Department of Clinical and Experimental Medicine, Thrombosis Center, University of Insubria, Varese, Italy
,
Francesco Dentali
1  Department of Clinical and Experimental Medicine, Thrombosis Center, University of Insubria, Varese, Italy
,
Alfonso Iorio
12  Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
,
James D. Douketis
13  Department of Medicine, McMaster University, Hamilton, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Received: 23 April 2013

Accepted after major revision: 12 September 2013

Publication Date:
29 November 2017 (online)

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.