Department of Internal Medicine and Clinical Investigation Center, Montpellier University Hospital, Montpellier University, Montpellier, France.
Department of Vascular Medicine, Amiens University Hospital, Amiens, France.
J Thromb Haemost. 2017 Jun;15(6):1123-1131. doi: 10.1111/jth.13679. Epub 2017 May 5.
Essentials Long-term risk of recurrence of isolated superficial vein thrombosis (SVT) is under-studied. We analyzed data from a cohort of first SVT and proximal deep vein thrombosis (DVT) without cancer. The risk of recurrence as DVT or pulmonary embolism is twice lower in SVT patients. However, overall risk of recurrence is similar between SVT and proximal DVT patients. Click to hear Dr Decousus' perspective on superficial vein thrombosis SUMMARY: Background Isolated superficial vein thrombosis (iSVT) (without concomitant deep vein thrombosis [DVT] or pulmonary embolism [PE]) is a frequent event, but available data on long-term outcomes are scarce and retrospective. Therefore, we aimed to determine prospectively the risk and type of venous thromboembolism (VTE) recurrence after iSVT and compare them with those of proximal DVT. Methods Using data from the prospective, multicenter, observational, OPTIMEV study, we assessed, at 3 years and after anticoagulants were stopped, the incidence and the type of VTE recurrence (iSVT/DVT/PE) of patients with a first objectively confirmed iSVT without cancer (n = 285), and compared these with those of patients with a first proximal DVT without cancer (n = 262). Results As compared with proximal DVT patients, iSVT patients had a similar overall incidence of VTE recurrence (5.4% per patient-year [PY] versus 6.5% per PY, adjusted hazard ratio [aHR] 0.9, 95% confidence interval [CI] 0.5-1.6), but iSVT recurred six times more often as iSVT (2.7% versus 0.6%, aHR 5.9, 95% CI 1.3-27.1) and 2.5 times less often as deep-VTE events (2.5% versus 5.9%, aHR 0.4, 95% CI 0.2-0.9). Varicose vein status did not influence the risk or the type of VTE recurrence. Saphenian junction involvement by iSVT was not associated with a higher risk of recurrence (5.2% per PY versus 5.4% per PY), but was associated with recurrence exclusively as deep-VTE events. Conclusion In patients with a first iSVT without cancer, after stopping anticoagulants, the incidence of deep-VTE recurrence is half that of DVT patients, but the overall risk of recurrence is similar. Ssaphenian junction involvement seems to influence the risk of deep-VTE recurrence, whereas varicose vein status has no impact or a low impact on VTE recurrence.
孤立性浅表静脉血栓形成（SVT）的长期复发风险研究较少。我们分析了来自首次 SVT 和无癌症的近端深静脉血栓形成（DVT）队列的数据。SVT 患者的 DVT 或肺栓塞复发风险降低两倍。然而，SVT 和近端 DVT 患者的总体复发风险相似。点击听取 Decousus 博士对浅表静脉血栓形成的看法。总结：背景孤立性浅表静脉血栓形成（iSVT）（无伴发深静脉血栓形成 [DVT] 或肺栓塞 [PE]）是一种常见的事件，但关于长期结果的可用数据很少且为回顾性的。因此，我们旨在前瞻性地确定 iSVT 后静脉血栓栓塞症（VTE）复发的风险和类型，并将其与近端 DVT 患者进行比较。方法利用来自前瞻性、多中心、观察性 OPTIMEV 研究的数据，我们评估了 3 年时和停止抗凝治疗后，首次经客观证实的无癌症 iSVT（n=285）患者的 VTE 复发（iSVT/DVT/PE）发生率和类型，并将其与首次无癌症近端 DVT 患者（n=262）进行了比较。结果与近端 DVT 患者相比，iSVT 患者的总体 VTE 复发发生率相似（患者年 5.4%[每患者年]与 6.5%[每患者年]，调整后的危险比 [aHR]0.9，95%置信区间 [CI]0.5-1.6），但 iSVT 复发作为 iSVT 的次数多六倍（2.7%与 0.6%，aHR5.9，95%CI1.3-27.1），作为深静脉血栓形成事件的次数少两倍（2.5%与 5.9%，aHR0.4，95%CI0.2-0.9）。静脉曲张状态并不影响 VTE 复发的风险或类型。iSVT 累及隐股交界部位与更高的复发风险无关（患者年 5.2%与患者年 5.4%），但与深静脉血栓形成事件复发有关。结论在无癌症的首次 iSVT 患者中，停止抗凝治疗后，深静脉血栓形成复发的发生率为 DVT 患者的一半，但总体复发风险相似。隐股交界部位受累似乎会影响深静脉血栓形成事件的复发风险，而静脉曲张状态对静脉血栓栓塞症复发的影响不大或影响较小。
