Abstract Number: PB2350
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Prophylaxis
Background: Superficial vein thrombosis (SVT) of the lower limbs is associated with an increased risk of short-term and also long-term risk of recurrent venous thromboembolism (VTE), but risk factors and frequency of late VTE up to five years are unknown.
Aims: To identify risk factors and frequency of recurrent VTE in patients with lower limb SVT beyond the initial three-month period of high risk.
Methods: Consecutive patients with SVT were treated with subcutaneous tinzaparin (Innohep, LEOPharma, Denmark) for up to three months. Patients with thrombi measuring less than 5 cm on Duplex or reaching the saphenofemoral junction (last 3 cm of the great saphenous vein) were excluded. The composite primary endpoint of this prospective cohort study was recurrent VTE, defined as occurrence of clinically evident SVT recurrence, deep-vein thrombosis or pulmonary embolism, developing after three months. Demographics, clinical and ultrasonic variables were recorded.
Results: A total of 147 patients with a median age of 58.2 years were treated. Two patients died of VTE during the first three months. The remaining 145 patients were followed-up for a maximum of five years, with 19 episodes of recurrent VTE occurring in 13/145 patients (9%), including 15 events of recurrent SVT, three events of deep-vein thrombosis and one event of pulmonary embolism. On univariable Cox regression, several factors showed association with recurrent VTE during the five-year follow-up period (Table, p≤0.20, selected for multivariable Cox regression analysis). Only erythema over the thrombosis area at two weeks and development of VTE during the initial three-months (Figure) were independent predictors of recurrent VTE during long-term follow-up (hazard ratio 3.6 and 4.1, respectively, and p=0.030 and p=0.035, respectively).
Conclusions: The risk of recurrent VTE in patients with SVT continues for several years after the initial event. Erythema and early VTE seem to represent proinflammatory and prothrombotic conditions, respectively.
| Variable | Hazard ratio | p value |
| SVT of the left leg | 1.7 | 0.077 |
| Presence of contralateral varicose veins | 3.8 | 0.200 |
| Dyskinesia at baseline | 1.8 | 0.130 |
| Dyskinesia at two weeks | 2.1 | 0.151 |
| Erythema over the thrombosis area at two weeks | 1.8 | 0.053 |
| Swelling of the leg at three months | 3.2 | 0.028 |
| Development of VTE events, including symptomatic recurrent SVT, during the run-in phase of three months | 3.3 | 0.068 |
[On univariable Cox regression, several factors showed association with recurrent VTE during the five-year follow-up period.]
[Erythema over the thrombosis area at two weeks and development of VTE during the initial three-months were independent predictors of reccurent VTE.]
To cite this abstract in AMA style:
Nikolakopoulos KM, Kakkos S, Papageorgopoulou CP, Ntouvas I, Papadoulas S, Kouri A, Tsantrizos P. Risk Factors and Frequency of Recurrent Long-Term Venous Thromboembolism After Superficial Vein Thrombosis of The Lower Limbs [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/risk-factors-and-frequency-of-recurrent-long-term-venous-thromboembolism-after-superficial-vein-thrombosis-of-the-lower-limbs/. Accessed October 1, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/risk-factors-and-frequency-of-recurrent-long-term-venous-thromboembolism-after-superficial-vein-thrombosis-of-the-lower-limbs/