The Persistance of Residual Vein Thrombosis, after an Episode of Deep Vein Thrombosis, and the Risk of New Overt Cancer and Cardiovascular Disease.

Siragusa, Sergio; Malato, Alessandra; Anastasio, Raffaela; Abbene, Ignazio; Arcara, Carlo; Lo Coco, Lucio; Casuccio, Alessandra

doi:10.1182/blood.V106.11.262.262

Abstract

Background. We have recently demonstrated that the presence of Residual Vein Thrombosis (RVT), UltraSonography (US)-detected at the 3^rd month after an episode of Deep Vein Thrombosis (DVT) of the lower limbs, is an independent risk factor for developing recurrent Venous Thromboembolism (VTE). The management of DVT patients by detection of RVT may, therefore, represent a simple and reproducible method for establishing the individual risk of recurrence and for tailoring the optimal duration of Oral Anticoagulants (OA) (

Siragusa S et al.

Blood

2003

;

102

(11):

OC183a

). At the present, it is unknown whether RVT may also identify patients at increased risk for cancer and/or cardiovascular disease (CD).

Objective of the study. In patients with DVT of the lower limbs, we conducted a prospective study for evaluating the correlation between RVT and the risk of new overt cancer and/or CD.

Materials and methods. Consecutive patients, with an episode of idiopathic or provoked DVT, were evaluated after 3 months from the index DVT; presence/absence of RVT was detected and patients managed consequently (table). The incidence of VTE recurrence, overt cancer and new CD was evaluated over a period of 3 years after the index DVT. Survival curves (Kaplan-Mayer) and related Breslow test have been used for statistics.

Results. Three-hundred fourty-five patients were included in the analysis. The results are listed in the table and figures. The incidence of recurrent VTE and new overt cancer was statistically lower in patients without RVT than in those with RVT; no significant differences were found in the incidence of new CD. These data are applicable in patients with idiopathic or provoked index DVT. In patients with RVT, the advantage of prolonging anticoagulation for 12 months was lost at the end of the treatment.

Conclusions. This is the first study evaluating the relationship between US-detected RVT and the risk of developing cancer and CD; RVT presence, at 3^rd month from the index DVT, is an independent risk factor for recurrent VTE and indicates patients at risk for new overt cancer. This risk remains over a period of 3 years, independently whether index DVT was idiopathic or provoked. In these patients, the advantage of indefinite anticoagulation should be assessed in properly designed study.

Incidence of events over a period of 3 years accordingly to RVT findings

Group	Number of patients	Presence of RVT at the 3rd months of OA from the index DVT	Duration of OA from the index DVT	Incidence of recurrent VTE	Incidence of new cancer	Incidence of new CD
*Part of these patients were originally randomized to receive 3 or 12 months of OA
Group *A1	142	yes	12 months	11 (7.7%)	8 (5.6%)	7 (4.9%)
Group *A2	91	yes	3 months	16 (17.5%)	9 (9.9%)	7 (7.7%)
Group B	112	no	3 months	1 (0.9%)	3 (2.6%)	4 (3.5%)

Group	Number of patients	Presence of RVT at the 3rd months of OA from the index DVT	Duration of OA from the index DVT	Incidence of recurrent VTE	Incidence of new cancer	Incidence of new CD
*Part of these patients were originally randomized to receive 3 or 12 months of OA
Group *A1	142	yes	12 months	11 (7.7%)	8 (5.6%)	7 (4.9%)
Group *A2	91	yes	3 months	16 (17.5%)	9 (9.9%)	7 (7.7%)
Group B	112	no	3 months	1 (0.9%)	3 (2.6%)	4 (3.5%)