Authors:	Valerio, Luca Ambaglio, Chiara Barone, Marisa Ciola, Mariella Konstantinides, Stavros Mahmoudpour, Seyed Hamidreza Picchi, Chiara Pieresca, Carla Trinchero, Alice Barco, Stefano
Title:	Recurrence risk after first symptomatic distal versus proximal deep vein thrombosis according to baseline risk factors
Online publication date:	11-Jul-2019
Year of first publication:	2019
Language:	english
Abstract:	Background   It remains unclear whether the distal location of deep vein thrombosis (DVT) is independently independently associated with a lower risk of recurrence in all patients, or represents a marker of the the presence and severity of provoking factors for venous thromboembolism (VTE). Methods We investigated investigated the impact of distal (vs. proximal) DVT location on the risk of developing symptomatic symptomatic, objectively confirmed recurrent VTE in 831 patients with a first acute symptomatic DVT not associated with pulmonary embolism (PE), who were stratified by the presence of transient or persistent risk factors at baseline. The primary outcome was symptomatic, objectively diagnosed recurrent recurrent VTE, including proximal DVT and PE. Results   A total of 205 (24.7%) patients presented with with a transient risk factor, 189 (22.7%) with a minor persistent risk factor, 202 (24.3%) with unprovoked unprovoked DVT, and 235 (28.3%) with cancer-associated DVT. One-hundred twenty-five patients (15.0%) experienced recurrent DVT or PE. The largest relative difference between patients with distal (vs. proximal) DVT was observed in the absence of identifiable risk factors (adjusted hazard ratio ratio [aHR]: 0.11; 95% CI [confidence interval]: 0.03-0.45). In patients with cancer, distal and proximal DVT had a comparable risk of recurrence (aHR: 0.70; 95% CI: 0.28-1.78]). Conclusions   The distal (vs. proximal) location of first acute symptomatic DVT represented, in the absence of any identifiable identifiable transient or persistent risk factors, a favorable prognostic factor for recurrence. In contrast, the prognostic impact of DVT location was weaker if persistent provoking risk factors for VTE were present, notably cancer.
DDC:	610 Medizin 610 Medical sciences
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 04 Medizin
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-178
Version:	Published version
Publication type:	Zeitschriftenaufsatz
License:	CC BY
Information on rights of use:	https://creativecommons.org/licenses/by/4.0/
Journal:	TH open 3 1
Pages or article number:	e58 e63
Publisher:	Thieme
Publisher place:	Stuttgart
Issue date:	2019
ISSN:	2512-9465 2567-3459
Publisher URL:	http://dx.doi.org/10.1055/s-0039-1683374
Publisher DOI:	10.1055/s-0039-1683374
Appears in collections:	JGU-Publikationen