The Long-Term Clinical Course of Acute Deep Venous Thrombosis

TLDR

Long‑term risk of recurrent venous thromboembolism and post‑thrombotic sequelae after symptomatic deep venous thrombosis is poorly documented. The study aimed to determine the 8‑year clinical course after a first symptomatic deep venous thrombosis episode. A prospective cohort of 355 consecutive patients from a university outpatient thrombosis clinic was followed for recurrent venous thromboembolism, post‑thrombotic syndrome, and death. Over 8 years, 30.3% of patients experienced recurrent venous thromboembolism and 29.1% developed post‑thrombotic syndrome, with cancer and impaired coagulation inhibition increasing risk, surgery and trauma decreasing risk, and ipsilateral recurrent DVT strongly predicting post‑thrombotic syndrome; 70.2% survived, but cancer markedly raised mortality, underscoring the need to reconsider short‑course anticoagulation.

Abstract

In patients who have symptomatic deep venous thrombosis, the long-term risk for recurrent venous thromboembolism and the incidence and severity of post-thrombotic sequelae have not been well documented.To determine the clinical course of patients during the 8 years after their first episode of symptomatic deep venous thrombosis.Prospective cohort study.University outpatient thrombosis clinic.355 consecutive patients with a first episode of symptomatic deep venous thrombosis.Recurrent venous thromboembolism, the post-thrombotic syndrome, and death. Potential risk factors for these outcomes were also evaluated.The cumulative incidence of recurrent venous thromboembolism was 17.5% after 2 years of follow-up (95% CI, 13.6% to 22.2%), 24.6% after 5 years (CI, 19.6% to 29.7%), and 30.3% after 8 years (CI, 23.6% to 37.0%). The presence of cancer and of impaired coagulation inhibition increased the risk for recurrent venous thromboembolism (hazard ratios, 1.72 [CI, 1.31 to 2.25] and 1.44 [CI, 1.02 to 2.01], respectively). In contrast, surgery and recent trauma or fracture were associated with a decreased risk for recurrent venous thromboembolism (hazard ratios, 0.36 [CI, 0.21 to 0.62] and 0.51 [CI, 0.32 to 0.87], respectively). The cumulative incidence of the post-thrombotic syndrome was 22.8% after 2 years (CI, 18.0% to 27.5%), 28.0% after 5 years (CI, 22.7% to 33.3%), and 29.1% after 8 years (CI, 23.4% to 34.7%). The development of ipsilateral recurrent deep venous thrombosis was strongly associated with the risk for the post-thrombotic syndrome (hazard ratio, 6.4; CI, 3.1 to 13.3). Survival after 8 years was 70.2% (CI, 64.7% to 75.6%). The presence of cancer increased the risk for death (hazard ratio, 8.1; CI, 3.6 to 18.1).Patients with symptomatic deep venous thrombosis, especially those without transient risk factors for deep venous thrombosis, have a high risk for recurrent venous thromboembolism that persists for many years. The post-thrombotic syndrome occurs in almost one third of these patients and is strongly related to ipsilateral recurrent deep venous thrombosis. These findings challenge the widely adopted use of short-course anticoagulation therapy in patients with symptomatic deep venous thrombosis.