Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry
Por:
Newton DH, Monreal Bosch M, Amendola M, Wolfe L, Perez Ductor C, Lecumberri R, Levy MM and RIETE Investigators
Publicada:
1 ene 2017
Resumen:
Objective: We sought to determine the risk factors for subsequent
bleeding and recurrent venous thromboembolism (VTE) events following
isolated noncatheter-associated upper extremity deep venous thrombosis
(non-CA-UEDVT) to better inform future treatment decisions for this
group of patients.
Methods: The RIETE registry (Registro Informatizado de Enfermedad
TromboEmbolica [Computerized Registry of Patients with Venous
Thromboembol ism]) is a prospective international registry of patients
with objectively confirmed symptomatic VTE. Patients with a symptomatic,
isolated, proximal UEDVT from March 2001 through March 2015 were
analyzed. Any patient with an indwelling catheter or pacemaker lead at
the DVT site and at the time of thrombosis was considered to have a
CA-UEDVT and was excluded. Patient and treatment characteristics such as
age, gender, comorbidities, VTE risk factors, treatment drug, and
duration were collected. Outcomes examined included recurrent DVT,
subsequent pulmonary embolism (PE), and hemorrhage. Multivariate
analysis was performed using stepwise logistic regression.
Results: Of the 1100 patients who met the study criteria, 580 (53%) were
male. The mean age of the patients was 50 20 years, and overall patient
survival at 1 year was 85%. Recurrent VTE occurred in 59 patients
(5.4%). Of these, 46 patients (4%) had recurrent DVT, 10 (0.9%) had a PE
following UEDVT diagnosis, and 3 (0.3%) had both. PE was fatal in three
patients (03%). Bleeding occurred in 50 patients (4.5%), major bleeding
in 19 patients (1.7%), and fatal bleeding in 6 patients (0.5%). On
multivariate analysis, malignant disease was associated with VTE
recurrence (odds ratio [OR], 2.00; 95% confidence interval
[C1],1.04-3.45; P<.04), whereas hemorrhage was associated with age (OR,
1.03; 95% C1,1.01-1.05; P=.002) and malignant disease (OR, 2.53; 95% CI,
1.34-4.76; P<.005). Hemorrhage and recurrent VTE were also significantly
associated (OR, 2.79; 95% CI, 1.16-6.76; P<.03).
Conclusions: PE following non-CA-UEDVT is rare. Malignant disease was
associated with VTE recurrence. Age and malignant disease were
associated with hemorrhage, and VTE recurrence was associated with
hemorrhage. Further prospective studies should be undertaken to best
determine length of anticoagulation treatment for the varied populations
of patients with UEDVT.
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