TY - JOUR
T1 - A multicenter prospective study of risk factors and treatment of unusual site thrombosis
AU - Ma, Kim
AU - Wells, Phillip
AU - Guzman, Charlotte
AU - Anderson, David
AU - Blostein, Mark
AU - Hirsch, Andrew
AU - Lazo-Langner, Alejandro
AU - Kovacs, Michael J.
AU - Rodger, Marc
AU - Tagalakis, Vicky
AU - Kahn, Susan R.
N1 - Publisher Copyright:
© 2016 Elsevier Ltd.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Unusual site deep vein thrombosis (USDVT) is an uncommon form of venous thromboembolism (VTE) with heterogeneity in pathophysiology and clinical features. While the need for anticoagulation treatment is generally accepted, there is little data on optimal USDVT treatment. The TRUST study aimed to characterize the epidemiology, treatment and outcomes of USDVT. From 2008 to 2012, 152 patients were prospectively enrolled at 4 Canadian centers. After baseline, patients were followed at 6, 12 and 24 months. There were 97 (64%) cases of splanchnic, 33 (22%) cerebral, 14 (9%) jugular, 6 (4%) ovarian and 2 (1%) renal vein thrombosis. Mean age was 52.9 years and 113 (74%) cases were symptomatic. Of 72 (47%) patients tested as part of clinical care, 22 (31%) were diagnosed with new thrombophilia. Of 138 patients evaluated in follow-up, 66 (48%) completed at least 6 months of anticoagulation. Estrogen exposure or inflammatory conditions preceding USDVT were commonly associated with treatment discontinuation before 6 months, while previous VTE was associated with continuing anticoagulation beyond 6 months. During follow-up, there were 22 (16%) deaths (20 from cancer), 4 (3%) cases of recurrent VTE and no fatal bleeding events. Despite half of USDVT patients receiving < 6 months of anticoagulation, the rate of VTE recurrence was low and anticoagulant treatment appears safe. Thrombophilia testing was common and thrombophilia prevalence was high. Further research is needed to determine the optimal investigation and management of USDVT.
AB - Unusual site deep vein thrombosis (USDVT) is an uncommon form of venous thromboembolism (VTE) with heterogeneity in pathophysiology and clinical features. While the need for anticoagulation treatment is generally accepted, there is little data on optimal USDVT treatment. The TRUST study aimed to characterize the epidemiology, treatment and outcomes of USDVT. From 2008 to 2012, 152 patients were prospectively enrolled at 4 Canadian centers. After baseline, patients were followed at 6, 12 and 24 months. There were 97 (64%) cases of splanchnic, 33 (22%) cerebral, 14 (9%) jugular, 6 (4%) ovarian and 2 (1%) renal vein thrombosis. Mean age was 52.9 years and 113 (74%) cases were symptomatic. Of 72 (47%) patients tested as part of clinical care, 22 (31%) were diagnosed with new thrombophilia. Of 138 patients evaluated in follow-up, 66 (48%) completed at least 6 months of anticoagulation. Estrogen exposure or inflammatory conditions preceding USDVT were commonly associated with treatment discontinuation before 6 months, while previous VTE was associated with continuing anticoagulation beyond 6 months. During follow-up, there were 22 (16%) deaths (20 from cancer), 4 (3%) cases of recurrent VTE and no fatal bleeding events. Despite half of USDVT patients receiving < 6 months of anticoagulation, the rate of VTE recurrence was low and anticoagulant treatment appears safe. Thrombophilia testing was common and thrombophilia prevalence was high. Further research is needed to determine the optimal investigation and management of USDVT.
KW - Risk factors
KW - Treatment
KW - Unusual site thrombosis
KW - Venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=84975147996&partnerID=8YFLogxK
U2 - 10.1016/j.thromres.2016.04.014
DO - 10.1016/j.thromres.2016.04.014
M3 - Article
C2 - 27318246
AN - SCOPUS:84975147996
SN - 0049-3848
VL - 144
SP - 100
EP - 105
JO - Thrombosis Research
JF - Thrombosis Research
ER -