Residual vein obstruction as a predictor for recurrent thromboembolic events after a first unprovoked episode

Data from the REVERSE cohort study

G. Le Gal, M. Carrier, M. J. Kovacs, M. T. Betancourt, S. R. Kahn, P. S. Wells, D. A. Anderson, I. Chagnon, S. Solymoss, M. Crowther, M. Righini, A. Delluc, Richard H White, L. Vickars, M. Rodger

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives: There is growing interest in using residual vein obstruction (RVO) to guide the duration of oral anticoagulant therapy (OAT) for unprovoked deep vein thrombosis (DVT). We sought to determine if RVO as determined by compression ultrasonography (CUS) after completion of 5-7months of anticoagulation for unprovoked DVT is associated with an increased risk of recurrent venous thromboembolism (VTE). Materials and Methods:This was a multicentre multinational prospective cohort study undertaken in tertiary care centers. Patients with a first 'unprovoked' major VTE were enrolled over a 4-year period and completed a mean 18-month follow-up in September 2006. All 452 patients with DVT had baseline CUS at inclusion to assess any RVO before stopping OAT at 5-7months. During follow-up off OAT, all episodes of suspected recurrent VTE were independently adjudicated with reference to baseline imaging. Results:Forty-five out of 231 patients with abnormal CUS (19.5%) had recurrent VTE during follow-up, as compared with 32 out of 220 patients with normal CUS (14.6%), and one patient had inadequate CUS. There was no significant association between an abnormal CUS at inclusion and the risk of recurrent VTE: hazard ratio 1.4 (95% confidence interval, 0.9-2.1), P=0.19. None of the different degrees of clot resolution on baseline CUS was statistically significantly associated with the risk of recurrent VTE. Conclusion:In our study, the presence of RVO at the time of OAT withdrawal was not associated with a statistically significant higher risk of recurrent VTE. RVO assessment may not be useful to guide duration of anticoagulation.

Original languageEnglish (US)
Pages (from-to)1126-1132
Number of pages7
JournalJournal of Thrombosis and Haemostasis
Volume9
Issue number6
DOIs
StatePublished - Jun 2011

Fingerprint

Venous Thromboembolism
Veins
Ultrasonography
Cohort Studies
Anticoagulants
Venous Thrombosis
Therapeutics
Tertiary Care Centers
Prospective Studies
Confidence Intervals

Keywords

  • Deep vein thrombosis
  • Pulmonary embolism
  • Recurrence
  • Residual vein thrombosis

ASJC Scopus subject areas

  • Hematology

Cite this

Residual vein obstruction as a predictor for recurrent thromboembolic events after a first unprovoked episode : Data from the REVERSE cohort study. / Le Gal, G.; Carrier, M.; Kovacs, M. J.; Betancourt, M. T.; Kahn, S. R.; Wells, P. S.; Anderson, D. A.; Chagnon, I.; Solymoss, S.; Crowther, M.; Righini, M.; Delluc, A.; White, Richard H; Vickars, L.; Rodger, M.

In: Journal of Thrombosis and Haemostasis, Vol. 9, No. 6, 06.2011, p. 1126-1132.

Research output: Contribution to journalArticle

Le Gal, G, Carrier, M, Kovacs, MJ, Betancourt, MT, Kahn, SR, Wells, PS, Anderson, DA, Chagnon, I, Solymoss, S, Crowther, M, Righini, M, Delluc, A, White, RH, Vickars, L & Rodger, M 2011, 'Residual vein obstruction as a predictor for recurrent thromboembolic events after a first unprovoked episode: Data from the REVERSE cohort study', Journal of Thrombosis and Haemostasis, vol. 9, no. 6, pp. 1126-1132. https://doi.org/10.1111/j.1538-7836.2011.04240.x
Le Gal, G. ; Carrier, M. ; Kovacs, M. J. ; Betancourt, M. T. ; Kahn, S. R. ; Wells, P. S. ; Anderson, D. A. ; Chagnon, I. ; Solymoss, S. ; Crowther, M. ; Righini, M. ; Delluc, A. ; White, Richard H ; Vickars, L. ; Rodger, M. / Residual vein obstruction as a predictor for recurrent thromboembolic events after a first unprovoked episode : Data from the REVERSE cohort study. In: Journal of Thrombosis and Haemostasis. 2011 ; Vol. 9, No. 6. pp. 1126-1132.
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abstract = "Objectives: There is growing interest in using residual vein obstruction (RVO) to guide the duration of oral anticoagulant therapy (OAT) for unprovoked deep vein thrombosis (DVT). We sought to determine if RVO as determined by compression ultrasonography (CUS) after completion of 5-7months of anticoagulation for unprovoked DVT is associated with an increased risk of recurrent venous thromboembolism (VTE). Materials and Methods:This was a multicentre multinational prospective cohort study undertaken in tertiary care centers. Patients with a first 'unprovoked' major VTE were enrolled over a 4-year period and completed a mean 18-month follow-up in September 2006. All 452 patients with DVT had baseline CUS at inclusion to assess any RVO before stopping OAT at 5-7months. During follow-up off OAT, all episodes of suspected recurrent VTE were independently adjudicated with reference to baseline imaging. Results:Forty-five out of 231 patients with abnormal CUS (19.5{\%}) had recurrent VTE during follow-up, as compared with 32 out of 220 patients with normal CUS (14.6{\%}), and one patient had inadequate CUS. There was no significant association between an abnormal CUS at inclusion and the risk of recurrent VTE: hazard ratio 1.4 (95{\%} confidence interval, 0.9-2.1), P=0.19. None of the different degrees of clot resolution on baseline CUS was statistically significantly associated with the risk of recurrent VTE. Conclusion:In our study, the presence of RVO at the time of OAT withdrawal was not associated with a statistically significant higher risk of recurrent VTE. RVO assessment may not be useful to guide duration of anticoagulation.",
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T1 - Residual vein obstruction as a predictor for recurrent thromboembolic events after a first unprovoked episode

T2 - Data from the REVERSE cohort study

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AU - Carrier, M.

AU - Kovacs, M. J.

AU - Betancourt, M. T.

AU - Kahn, S. R.

AU - Wells, P. S.

AU - Anderson, D. A.

AU - Chagnon, I.

AU - Solymoss, S.

AU - Crowther, M.

AU - Righini, M.

AU - Delluc, A.

AU - White, Richard H

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AU - Rodger, M.

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N2 - Objectives: There is growing interest in using residual vein obstruction (RVO) to guide the duration of oral anticoagulant therapy (OAT) for unprovoked deep vein thrombosis (DVT). We sought to determine if RVO as determined by compression ultrasonography (CUS) after completion of 5-7months of anticoagulation for unprovoked DVT is associated with an increased risk of recurrent venous thromboembolism (VTE). Materials and Methods:This was a multicentre multinational prospective cohort study undertaken in tertiary care centers. Patients with a first 'unprovoked' major VTE were enrolled over a 4-year period and completed a mean 18-month follow-up in September 2006. All 452 patients with DVT had baseline CUS at inclusion to assess any RVO before stopping OAT at 5-7months. During follow-up off OAT, all episodes of suspected recurrent VTE were independently adjudicated with reference to baseline imaging. Results:Forty-five out of 231 patients with abnormal CUS (19.5%) had recurrent VTE during follow-up, as compared with 32 out of 220 patients with normal CUS (14.6%), and one patient had inadequate CUS. There was no significant association between an abnormal CUS at inclusion and the risk of recurrent VTE: hazard ratio 1.4 (95% confidence interval, 0.9-2.1), P=0.19. None of the different degrees of clot resolution on baseline CUS was statistically significantly associated with the risk of recurrent VTE. Conclusion:In our study, the presence of RVO at the time of OAT withdrawal was not associated with a statistically significant higher risk of recurrent VTE. RVO assessment may not be useful to guide duration of anticoagulation.

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KW - Pulmonary embolism

KW - Recurrence

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