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Galanaud JP, Sevestre MA, Pernod G, Vermorel C, Rolland C, Soudet S, Laroche JP, Bosson JL. Isolated distal deep vein thrombosis: What have we learnt from the OPTIMEV study? JOURNAL DE MEDECINE VASCULAIRE 2023; 48:3-10. [PMID: 37120268 DOI: 10.1016/j.jdmv.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 05/01/2023]
Abstract
The OPTIMEV (OPTimisation de l'Interrogatoire dans l'évaluation du risque throMbo-Embolique Veineux) study has provided some important and innovative information for the management of lower extremity isolated distal deep vein thrombosis (distal DVT). Indeed, if distal deep-vein thrombosis (DVT) therapeutic management is nowadays still debated, before the OPTIMEV study, the clinical relevance of these DVT itself was questioned. Via the publication of 6 articles, between 2009 and 2022, assessing risk factors, therapeutic management, and outcomes of 933 patients with distal DVT we were able to demonstrate that: - When distal deep veins are systematically screened for suspicion of DVT, distal DVT are the most frequent clinical presentation of the venous thromboembolic disease (VTE). This is also true in case of combined oral contraceptive related VTE. - Distal DVT share the same risk factors as proximal DVT and constitute two different clinical expressions of the same disease: the VTE disease. However, the weight of these risk factors differs: distal DVT are more often associated with transient risk factors whereas proximal DVT are more associated with permanent risk factors. - Deep calf vein and muscular DVT share the same risk factors, short and long-term prognoses. - In patients without history of cancer, risk of unknown cancer is similar in patients with a first distal or proximal DVT. - After 3years and once anticoagulation has been stopped, distal DVT recur twice less as proximal DVT and mainly as distal DVT; However, in cancer patients, prognosis of distal and proximal DVT appear similar in terms of death and VTE recurrence.
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Affiliation(s)
- J-P Galanaud
- Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
| | - M-A Sevestre
- Department of Vascular Medicine, Amiens University Hospital, Amiens, France
| | - G Pernod
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - C Vermorel
- University Grenoble Alpes, CNRS, Department of Public Health, Grenoble-Alpes University Hospital and, TIMC-IMAG, 38000 Grenoble, France
| | - C Rolland
- University Grenoble Alpes, CNRS, Department of Public Health, Grenoble-Alpes University Hospital and, TIMC-IMAG, 38000 Grenoble, France
| | - S Soudet
- Department of Vascular Medicine, Amiens University Hospital, Amiens, France
| | - J-P Laroche
- Vascular Medicine Physician, Private practice office, Avignon, France
| | - J-L Bosson
- University Grenoble Alpes, CNRS, Department of Public Health, Grenoble-Alpes University Hospital and, TIMC-IMAG, 38000 Grenoble, France
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Di Vilio A, Vergara A, Desiderio A, Iodice F, Serio A, Palermi S, Gambardella F, Sperlongano S, Gioia R, Acitorio M, D'Andrea A. Incremental value of compression ultrasound sonography in the emergency department. World J Crit Care Med 2021; 10:194-203. [PMID: 34616656 PMCID: PMC8462022 DOI: 10.5492/wjccm.v10.i5.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/13/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis. Venous ultrasound (VU) is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis. Various protocols have been proposed for its execution, such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area. The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe. Initially, the thrombus is hypoechogenic and adherent to the vessel; later, it tends to organize and recanalize. Usually, in the early stages, the risk of embolism is higher. The role of studying the iliac axis and calf veins is still uncertain. VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.
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Affiliation(s)
- Alessandro Di Vilio
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Andrea Vergara
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Alfonso Desiderio
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
| | - Franco Iodice
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Alessandro Serio
- Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Stefano Palermi
- Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Francesco Gambardella
- Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Simona Sperlongano
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Renato Gioia
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno 84084, Italy
| | - Maria Acitorio
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
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Makedonov I, Galanaud JP, Kahn SR. Significance and management of isolated distal deep vein thrombosis. Curr Opin Hematol 2021; 28:331-338. [PMID: 34267078 DOI: 10.1097/moh.0000000000000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Management of isolated distal deep vein thrombosis (IDDVT) remains controversial. We summarize recent studies regarding the natural history of IDDVT as well as pertinent therapeutic trials. We also provide our management approach. RECENT FINDINGS IDDVT is more commonly associated with transient risk factors and less often associated with permanent, unmodifiable risk factors than proximal DVT. IDDVT has a significantly lower risk of proximal extension and recurrence than proximal DVT. Cancer-associated IDDVT has a similar natural history to cancer-associated proximal DVT, with substantially less favourable outcomes than noncancer-associated IDDVT. Anticoagulant treatment reduces the risk of proximal extension and recurrence in IDDVT at the cost of increased bleeding risk. Intermediate dosing of anticoagulation may be effective for treating noncancer-associated IDDVT in patients without prior DVT. SUMMARY IDDVT with a transient risk factor can be treated for 6 weeks in patients without a prior DVT. Unprovoked IDDVT in patients without malignancy can be treated for 3 months. Outpatients without malignancy or a prior DVT can be left untreated and undergo surveillance compression ultrasound in one week to detect proximal extension, but few patients opt for this in practice. Cancer-associated IDDVT should be treated analogously to cancer-associated proximal DVT.
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Affiliation(s)
- Ilia Makedonov
- Department of Medicine, Division of General Internal Medicine, Sunnybrook Health Sciences Center
| | - Jean-Philippe Galanaud
- Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - Susan R Kahn
- Center for Clinical Epidemiology, Jewish General Hospital/Lady Davis Institute; Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada
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Kraaijpoel N, Mulder FI, Carrier M, van Lieshout A, Würdinger T, Best MG, van Vlijmen BJ, Mohammed Y, Jara-Palomares L, Kamphuisen PW, Di Nisio M, Ageno W, Beyer-Westendorf J, Vanassche T, Klokm FA, Otten HM, Peters MJ, Cosmi B, Wolde MT, Bossuyt PM, Büller HR, van Es N. Novel biomarkers to detect occult cancer in patients with unprovoked venous thromboembolism: Rationale and design of the PLATO-VTE study. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2020.100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Galanaud JP, Blaise S, Sevestre MA, Terrisse H, Pernod G, Gaillard C, Genty C, Monreal M, Rabah Y, Kahn SR, Quéré I, Bosson JL. Long-term outcomes of isolated superficial vein thrombosis in patients with active cancer. Thromb Res 2018; 171:179-186. [DOI: 10.1016/j.thromres.2018.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 02/01/2023]
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Needleman L, Cronan JJ, Lilly MP, Merli GJ, Adhikari S, Hertzberg BS, DeJong MR, Streiff MB, Meissner MH. Ultrasound for Lower Extremity Deep Venous Thrombosis. Circulation 2018; 137:1505-1515. [DOI: 10.1161/circulationaha.117.030687] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Venous ultrasound is the standard imaging test for patients suspected of having acute deep venous thrombosis (DVT). There is variability and disagreement among authoritative groups regarding the necessary components of the test. Some protocols include scanning the entire lower extremity, whereas others recommend scans limited to the thigh and knee supplemented with serial testing. Some protocols use gray-scale ultrasound alone, whereas others include Doppler interrogation. Point-of-care ultrasound is recommended in some settings, and there is heterogeneity of these protocols as well. Heterogeneity of recommendations can lead to errors including incorrect application of guidelines, confusion among requesting physicians, and incorrect follow-up. In October 2016, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to evaluate the current evidence to develop recommendations regarding ultrasound protocols for DVT and the terminology used to communicate results to clinicians. Recommendations were made after open discussion and by unanimous consensus.
The panel recommends a comprehensive duplex ultrasound protocol from thigh to ankle with Doppler at selected sites rather than a limited or complete compression-only examination. This protocol is currently performed in many facilities and is achievable with standard ultrasound equipment and personnel. The use of these recommendations will increase the diagnosis of calf DVT and provide better data to explain the presenting symptoms. The panel recommends a single point-of-care protocol that minimizes underdiagnoses of proximal DVT.
The panel recommends the term chronic postthrombotic change to describe the residual material that persists after the acute presentation of DVT to avoid potential overtreatment of prior thrombus.
Adoption of a single standardized comprehensive duplex ultrasound and a single point-of-care examination will enhance patient safety and clinicians’ confidence.
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Affiliation(s)
| | - John J. Cronan
- Department of Diagnostic Imaging, Brown University, Providence, RI (J.J.C.)
| | - Michael P. Lilly
- Department of Surgery, University of Maryland School of Medicine, Baltimore (M.P.L.)
| | - Geno J. Merli
- Department of Medicine (G.J.M.), Thomas Jefferson University, Philadelphia, PA
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson (S.A.)
| | - Barbara S. Hertzberg
- Department of Radiology, Duke University School of Medicine, Durham, NC (B.S.H.)
| | | | - Michael B. Streiff
- Department of Medicine (M.B.S.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Mark H. Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle (M.H.M.)
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Barco S, Corti M, Trinchero A, Picchi C, Ambaglio C, Konstantinides SV, Dentali F, Barone M. Survival and recurrent venous thromboembolism in patients with first proximal or isolated distal deep vein thrombosis and no pulmonary embolism. J Thromb Haemost 2017; 15:1436-1442. [PMID: 28439954 DOI: 10.1111/jth.13713] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Indexed: 12/11/2022]
Abstract
Essentials The long-term risk of recurrence and death after distal deep vein thrombosis (DVT) is uncertain. We included subjects with first proximal or isolated distal DVT (IDDVT) and no pulmonary embolism. The risk of symptomatic and asymptomatic recurrence is lower after IDDVT (vs. proximal). IDDVT may be associated with a lower long-term risk of death, especially after unprovoked DVT. SUMMARY Background A few studies have focused on the risk of recurrence after first acute isolated distal deep vein thrombosis (IDDVT) compared with proximal DVT (PDVT), whereas the incremental risk of death has never been explored beyond the first 3 years after acute event. Methods Our single-center cohort study included patients with first symptomatic acute PDVT or IDDVT. Patients were excluded if they had concomitant pulmonary embolism (PE) or prior venous thromboembolism. The primary outcomes were symptomatic objectively diagnosed recurrent PDVT or PE and all-cause death. Results In total, 4759 records were screened and 831 subjects included: 202 had symptomatic IDDVT and 629 had PDVT. The median age was 66 years and 50.5% were women. A total of 125 patients had recurrent PDVT or PE during 3175 patient-years of follow-up: 109 events occurred after PDVT (17.3%) and 16 after IDDVT (7.9%). Annual recurrence rates were 4.5% (95% confidence interval [CI], 3.7-5.4%) and 2.0% (95% CI, 1.1-3.2%), respectively, for an adjusted hazard ratio (aHR) for IDDVT patients of 0.32 (95% CI, 0.19-0.55). Death occurred in 263 patients (31.6% [95% CI, 28.6-34.9%]) during 5469 patient-years of follow-up for an overall annual incidence rate of 4.8% (95% CI, 4.2-5.4%). The mortality rate was 33.5% (n = 211) in PDVT patients and 25.7% (n = 52) in IDDVT patients. The long-term hazard of death appeared lower for IDDVT patients (aHR, 0.75 [95% CI, 0.55-1.02]), especially after unprovoked events (aHR, 0.58 [95% CI, 0.26-1.31]). Conclusions Compared with PDVT, IDDVT patients were at a lower risk of recurrent VTE. The risk of death appeared lower after IDDVT during a median follow-up of 7.6 years.
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Affiliation(s)
- S Barco
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University-Mainz, Mainz, Germany
- Department of Internal Medicine, Fondazione IRCCS Policlinico 'San Matteo', Pavia, Italy
| | - M Corti
- Department of Internal Medicine, Fondazione IRCCS Policlinico 'San Matteo', Pavia, Italy
| | - A Trinchero
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University-Mainz, Mainz, Germany
- Department of Internal Medicine, Fondazione IRCCS Policlinico 'San Matteo', Pavia, Italy
| | - C Picchi
- Department of Internal Medicine, Fondazione IRCCS Policlinico 'San Matteo', Pavia, Italy
- Department of Internal Medicine, Presidio Ospedaliero 'Macedonio Melloni', ASST FBF 'Sacco', Milan, Italy
| | - C Ambaglio
- Department of Internal Medicine, Fondazione IRCCS Policlinico 'San Matteo', Pavia, Italy
| | - S V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University-Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - F Dentali
- Department of Clinical and Experimental Medicine, Ospedale di Circolo, Insubria University, Varese, Italy
| | - M Barone
- Department of Internal Medicine, Fondazione IRCCS Policlinico 'San Matteo', Pavia, Italy
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Galanaud JP, Sevestre MA, Pernod G, Kahn SR, Genty C, Terrisse H, Brisot D, Gillet JL, Quéré I, Bosson JL. Long-term risk of venous thromboembolism recurrence after isolated superficial vein thrombosis. J Thromb Haemost 2017; 15:1123-1131. [PMID: 28317330 DOI: 10.1111/jth.13679] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- J-P Galanaud
- Department of Internal Medicine and Clinical Investigation Center, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - M-A Sevestre
- Department of Vascular Medicine, Amiens University Hospital, Amiens, France
| | - G Pernod
- Department of Vascular Medicine, Grenoble University Hospital, Grenoble, France
| | - S R Kahn
- Department of Medicine, McGill University and Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Canada
| | - C Genty
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and, TIMC-IMAG, Grenoble, France
| | - H Terrisse
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and, TIMC-IMAG, Grenoble, France
| | - D Brisot
- Vascular medicine physician, Clapiers, France
| | - J-L Gillet
- Vascular medicine physician, Bourgoin-Jallieu, France
| | - I Quéré
- Department of Internal Medicine and Clinical Investigation Center, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - J-L Bosson
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and, TIMC-IMAG, Grenoble, France
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Galanaud JP, Sevestre MA, Pernod G, Genty C, Richelet S, Kahn SR, Boulon C, Terrisse H, Quéré I, Bosson JL. Long-term outcomes of cancer-related isolated distal deep vein thrombosis: the OPTIMEV study. J Thromb Haemost 2017; 15:907-916. [PMID: 28266773 DOI: 10.1111/jth.13664] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 12/21/2022]
Abstract
Essentials Clinical significance of cancer-related isolated distal deep vein thrombosis (iDDVT) is unknown. We studied patients with iDDVT, with and without cancer, and proximal DVT with cancer. Cancer-related iDDVT patients have a much poorer prognosis than iDDVT patients without cancer. Cancer-related iDDVT patients have a similar prognosis to cancer-related proximal DVT patients. SUMMARY Background Isolated distal deep vein thrombosis (iDDVT) (infra-popliteal DVT without pulmonary embolism [PE]) is a frequent event and, in the absence of cancer, is usually considered to be a minor form of venous thromboembolism (VTE). However, the clinical significance of cancer-related iDDVT is unknown. Methods Using data from the observational, prospective multicenter OPTIMEV cohort, we compared, at 3 years, the incidences of death, VTE recurrence and major bleeding in patients with cancer-related iDDVT with those in cancer patients with isolated proximal DVT (matched 1:1 on age and sex) and patients with iDDVT without cancer (matched 1:2 on age and sex). Results As compared with patients with cancer-related isolated proximal DVT (n = 92), those with cancer-related iDDVT (n = 92) had a similar risk of death (40.8% per patient-year (PY) vs. 38.3% per PY; aHR = 1.0, 95% CI[0.7-1.4]) and of major bleeding (3.8% per PY vs. 3.6% per PY, aCHR = 0.9 [0.3-3.2]) and a higher risk of VTE recurrence (5.4% per PY vs. 11.5% per PY; aCHR = 1.8 [0.7-4.5]). As compared with patients with iDDVT without cancer (n = 184), those with cancer-related iDDVT had a nine times higher risk of death (3.5% per PY vs. 38.3% per PY; aHR = 9.3 [5.5-15.9]), a higher risk of major bleeding (1.8% per PY vs. 3.6% per PY; aCHR = 2.0 [0.6-6.1]) and a higher risk of VTE recurrence (5.0% per PY vs. 11.5% per PY; aCHR = 2.0 [1.0-3.7]). The results remained similar in the subgroup of patients without history of VTE. Conclusion Patients with cancer-related iDDVT seem to have a prognosis that is similar to that of patients with cancer-related isolated proximal DVT and a dramatically poorer prognosis than patients with iDDVT without cancer. This underlines the high clinical significance of cancer-related iDDVT and the need for additional studies.
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Affiliation(s)
- J-P Galanaud
- Department of Internal Medicine and Clinical Investigation Centre, Montpellier University Hospital, EA 2992, Montpellier University, Montpellier, France
| | - M-A Sevestre
- Department of Vascular Medicine, Amiens University Hospital, Amiens, France
| | - G Pernod
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble-Alpes University Hospital and TIMC-IMAG, Grenoble, France
| | - C Genty
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble-Alpes University Hospital and TIMC-IMAG, Grenoble, France
| | - S Richelet
- Department of Cardiology and Vascular Medicine, William Morey Hospital, Chalon sur Saone, France
| | - S R Kahn
- Department of Medicine, McGill University and Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada
| | - C Boulon
- Department of Vascular Medicine, Bordeaux University Hospital, Bordeaux, France
| | - H Terrisse
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble-Alpes University Hospital and TIMC-IMAG, Grenoble, France
| | - I Quéré
- Department of Internal Medicine and Clinical Investigation Centre, Montpellier University Hospital, EA 2992, Montpellier University, Montpellier, France
| | - J-L Bosson
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble-Alpes University Hospital and TIMC-IMAG, Grenoble, France
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Arnoult AC, Pernod G, Genty C, Galanaud JP, Colonna M, Sevestre MA, Bosson JL. Low incidence of cancer after venous thromboembolism: An update from the French OPTIMEV Cohort. ACTA ACUST UNITED AC 2016; 41:169-75. [PMID: 27080824 DOI: 10.1016/j.jmv.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have shown lower rates of cancer following venous thromboembolism (VTE) than previously described. OBJECTIVES To reassess the risk of cancer in patients with clinical symptoms of VTE with or without confirmed VTE. PATIENTS We used data from OPTIMEV, a French prospective multicenter observational study of patients presenting to hospital and community vascular medicine specialists with suspected VTE. Patients with confirmed VTE (1565) and matched controls without VTE (1847) were followed for 3 years (2006-2009). The main outcome was occurrence of cancer at 3 years, and death was a censoring event. RESULTS A total of 5.0% [4.0-6.3] of patients with VTE and 3.8% [3.0-4.9] without VTE developed cancer during follow-up. The adjusted hazard ratio (HR) was 1.2 [0.9-1.8] for patients with confirmed VTE (P=0.22). The overall standardized incidence ratio (SIR) was 1.4 [1.1-1.6] for our population, VTE+ and VTE-, compared with the general population, statistically significant (P<0.05). CONCLUSIONS We found a lower occurrence of cancer after VTE than previously described, with no significant difference between patients whether VTE was confirmed or not. Our results (low incidence and no difference between patients VTE+ or VTE-) provide no argument in favor of an extensive screening for cancer in case of VTE.
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Affiliation(s)
- A-C Arnoult
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Geneva University Hospital, Division of Angiology and Hemostasis, CH-1211 Geneva 14, Switzerland
| | - G Pernod
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Grenoble University Hospital, Department of Vascular Medicine, 38043 Grenoble, France
| | - C Genty
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Grenoble University Hospital, Clinical Research Center, 38043 Grenoble, France
| | - J-P Galanaud
- Montpellier University Hospital, Clinical Research Center, Department of Internal Medicine, 34090 Montpellier, France
| | - M Colonna
- Grenoble University Hospital, Isère Cancer Registry, 38043 Grenoble, France
| | - M-A Sevestre
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Amiens University Hospital, Department of Vascular Medicine, 80000 Amiens, France
| | - J-L Bosson
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Grenoble University Hospital, Clinical Research Center, 38043 Grenoble, France.
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Galanaud JP, Messas E, Blanchet-Deverly A, Quéré I, Wahl D, Pernod G. Prise en charge de la maladie thromboembolique veineuse en 2015. Rev Med Interne 2015; 36:746-52. [DOI: 10.1016/j.revmed.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/01/2015] [Indexed: 01/16/2023]
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Galanaud JP, Sevestre MA, Genty C, Pernod G, Quere I, Bosson JL. Is it useful to also image the asymptomatic leg in patients with suspected deep vein thrombosis?: comment. J Thromb Haemost 2015; 13:2127-30. [PMID: 26332772 DOI: 10.1111/jth.13123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- J-P Galanaud
- Clinical Investigation Centre and Department of Internal Medicine, Montpellier University Hospital, Montpellier, France
| | - M-A Sevestre
- Department of Vascular Medicine, Amiens University Hospital, Amiens, France
| | - C Genty
- UJF Grenoble 1, CNRS, Department of Public Health, Grenoble University Hospital, TIMC-IMAG UMR 5525, Themas, Grenoble, France
| | - G Pernod
- UJF Grenoble 1, CNRS, Department of Public Health, Grenoble University Hospital, TIMC-IMAG UMR 5525, Themas, Grenoble, France
- Department of Vascular Medicine, Grenoble University Hospital, Grenoble, France
| | - I Quere
- Clinical Investigation Centre and Department of Internal Medicine, Montpellier University Hospital, Montpellier, France
| | - J-L Bosson
- UJF Grenoble 1, CNRS, Department of Public Health, Grenoble University Hospital, TIMC-IMAG UMR 5525, Themas, Grenoble, France
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Messas E, Wahl D, Pernod G. [Management of deep-vein thrombosis: A 2015 update]. ACTA ACUST UNITED AC 2015; 41:42-50. [PMID: 26357937 DOI: 10.1016/j.jmv.2015.07.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/10/2015] [Indexed: 11/26/2022]
Abstract
Deep vein thrombosis (DVT) is a frequent and multifactor disease, with two major complications, post thrombotic syndrome and pulmonary embolism. Both transient (surgery, plaster immobilization, bed rest/hospitalization) and chronic/persistent (age, cancer, clinical or biological thrombophilia…) risk factors modulate treatment duration. Diagnostic management relies on clinical evaluations, probability followed by laboratory tests or imaging. So far, compression ultrasound is the diagnostic test of choice to make a positive diagnosis of DVT. Anticoagulants at therapeutic dose for at least 3 months constitute the cornerstones of proximal (i.e. involving popliteal or more proximal veins) DVT therapeutic management. The arrival of new oral anticoagulants should optimize ambulatory management of DVT.
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Affiliation(s)
- E Messas
- Service de médecine vasculaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - D Wahl
- Service de médecine vasculaire, hôpital Brabois, CHU de Nancy, rue de Morvan, 54511 Vandœuvre-lès-Nancy cedex, France
| | - G Pernod
- Service de médecine vasculaire, université Grenoble Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, CHU de Grenoble, 38043 Grenoble cedex 09, France
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Almosni J, Meusy A, Frances P, Pontal D, Quéré I, Galanaud JP. Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares: A clinical practice survey. Thromb Res 2015; 136:526-30. [DOI: 10.1016/j.thromres.2015.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/01/2015] [Accepted: 06/11/2015] [Indexed: 11/25/2022]
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15
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Matzdorff A, Riess H, Bergmann F, Bisping G, Koschmieder S, Parmentier S, Petrides PE, Sosada M. Cancer Screening in Patients with Idiopathic Venous Thromboembolism - a Position Paper of the German Society of Hematology and Oncology Working Group on Hemostasis. Oncol Res Treat 2015; 38:454-8. [DOI: 10.1159/000437451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/25/2015] [Indexed: 11/19/2022]
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