Nagler, Michael; Ten Cate, Hugo; Prins, Martin H; Ten Cate-Hoek, Arina J (2018). Risk factors for recurrence in deep vein thrombosis patients following a tailored anticoagulant treatment incorporating residual vein obstruction. Research and practice in thrombosis and haemostasis, 2(2), pp. 299-309. Wiley 10.1002/rth2.12079
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Background
Finding the optimal duration of anticoagulant treatment following an acute event of deep vein thrombosis (DVT) is challenging. Residual venous obstruction (RVO) has been identified as a risk factor for recurrence, but data on management strategies incorporating the presence of RVO and associated recurrence rates in defined clinical care pathways (CCP) are lacking.
Objectives
We aimed to investigate the long-term clinical outcomes and predictors of venous thromboembolism (VTE) recurrence in a contemporary cohort of patients with proximal DVT and managed in a CCP incorporating the presence of RVO.
Patients
All patients treated at the Maastricht University Medical Center within an established clinical care pathway from June 2003 through June 2013 were prospectively followed for up to 11 years in a prospective management study.
Results
Of 479 patients diagnosed with proximal DVT, 474 completed the two-year CCP (99%), and 457 (94.7%) the extended follow-up (2231.2 patient-years; median follow-up 4.6 years). Overall VTE recurrence was 2.9 per 100 patient-years, 1.3 if provoked by surgery, 2.1 if a non-surgical transient risk factor was present and 4.0 if unprovoked. Predictors of recurrent events were unprovoked VTE (adjusted hazard ratio [HR] 4.6; 95% CI 1.7, 11.9), elevated D-dimer one month after treatment was stopped (HR 3.3; 1.8, 6.1), male sex (HR 2.8; 1.5, 5.1), high factor VIII (HR 2.2; 1.2, 4.0) and use of contraceptives (HR 0.1; 0.0, 0.9).
Conclusions
Patients with DVT managed within an established clinical care pathway incorporating the presence of RVO had relatively low incidences of VTE recurrence.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory 04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Hämatologie (Erwachsene) |
UniBE Contributor: |
Nagler, Michael |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2475-0379 |
Publisher: |
Wiley |
Language: |
English |
Submitter: |
Pierrette Durand Lüthi |
Date Deposited: |
28 Mar 2019 15:08 |
Last Modified: |
05 Dec 2022 15:24 |
Publisher DOI: |
10.1002/rth2.12079 |
PubMed ID: |
30046732 |
Uncontrolled Keywords: |
clinical decision making epidemiology health services research mortality risk factors therapy venous thromboembolism |
BORIS DOI: |
10.7892/boris.124547 |
URI: |
https://boris.unibe.ch/id/eprint/124547 |
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