Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492010000200010
Jornal Vascular Brasileiro
Review Article

Clinical significance of recurrent venous thromboembolism

Significância clínica de tromboembolismo venoso recorrente

Nicos Labropoulos; Georgios Spentzouris; Marcone Lima Sobreira

Downloads: 0
Views: 1193

Abstract

Recurrent venous thromboembolism is a significant problem leading to increased morbidity and mortality. It has a high impact on patients' quality of life and imposes a great financial burden on society. Cumulative recurrence has been reported as 40% at 10 years, while the chance of developing postthrombotic signs and symptoms in the lower extremities almost quadruples when ipsilateral. There is also a higher chance of developing pulmonary hypertension. Important factors for recurrence are unprovoked episodes of deep vein thrombosis, malignancy and older age. The evidence for other factors is controversial. Accurate diagnosis and treatment tailored to the patients' history, thrombotic events and risk factors are necessary to optimize management and prevent recurrence.

Keywords

Recurrent venous thromboembolism, postthrombotic syndrome, pulmonary hypertension, anticoagulation

Resumo

O tromboembolismo venoso recorrente é um problema importante que leva ao aumento da morbimortalidade. Impõe forte impacto à qualidade de vida dos pacientes e grande carga financeira para a sociedade. Acredita-se que a recorrência cumulativa atinja 40% em 10 anos, enquanto que a chance de desenvolver sinais e sintomas pós-trombóticos nas extremidades inferiores quase quadruplica no caso de trombose ipsilateral. Há também uma maior chance do desenvolvimento de hipertensão pulmonar. Fatores importantes para a recorrência são: episódios não provocados de trombose venosa profunda, malignidade e idade avançada. As evidências relacionadas a outros fatores são controversas. Diagnóstico preciso e tratamento adaptado ao histórico dos pacientes, aos eventos trombóticos e aos fatores de risco são necessários para otimizar o manejo e prevenir a recorrência.

Palavras-chave

Tromboembolismo venoso recorrente, síndrome pós-trombótica, hipertensão pulmonar, anticoagulação

References

Prandoni P, Noventa F, Ghirarduzzi A. The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism: A prospective cohort study in 1,626 patients. Haematologica. 2007;92:199-205.

Pradoni P, Lensing AW, Cogo A. The long term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125:1-7.

Labropoulos N, Gasparis AP, Tassiopoulos AK. Prospective evaluation of the clinical deterioration in post-thrombotic limbs. J Vasc Surg. 2009;50:826-30.

Abai B, Labropoulos N. Duplex ultrasound scanning for chronic venous obstruction and valvular incompetence. Hanbook of venous disorders. 2009:142-55.

Labropoulos N, Tiongson J, Pryor L. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003;38:793-8.

Prandoni P, Lensing AW, Bernardi E, Villalta S, Bagatella P, Girolami A. The diagnostic value of compression ultrasonography in patients with suspected recurrent deep vein Thrombosis. Thromb Haemost. 2002;88:402-6.

Linkins LA, Pasquale P, Paterson S, Kearon C. Change in thrombus length on venous ultrasound and recurrent deep vein thrombosis. Arch Intern Med. 2004;164:1793-6.

Rosen CL, Tracy JA. The diagnosis of lower extremity deep venous thrombosis. Emerg Med Clin North Am. 2001;19:895-912.

Carpenter JP, Holland GA, Baum RA, Owen RS, Carpenter JT, Cope C. Magnetic resonance venography for the detection of deep venous thrombosis: comparison with contrast venography and duplex Doppler ultrasonography. J Vasc Surg. 1993;18:734-41.

Froehlich JB, Prince MR, Greenfield LJ, Downing LJ, Shah NL, Wakefield TW. Bull's-eye" sign on gadolinium-enhanced magnetic resonance venography determines thrombus presence and age: a preliminary study. J Vasc Surg. 1997;26:809-16.

Labropoulos N, Waggoner T, Sammis W, Samali S, Pappas PJ. The effect of venous thrombus location and extent on the development of post-thrombotic signs and symptoms. J Vasc Surg. 2008;48:407-12.

Roumen-Klappe EM, den Heijer M, Janssen MC, van der Vleuten C, Thien T, Wollersheim H. The post-thrombotic syndrome: incidence and prognostic value of non-invasive venous examinations in a six-year follow-up study. Thromb Haemost. 2005;94:825-30.

Kahn SR, Shrier I, Julian JA. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149:698-707.

Prandoni P, Kahn SR. Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol. 2009;145:286-95.

Fedullo PF, Auger W, Kerr K, Rubin LJ. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2001;345:1465-72.

Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Circulation. 2006;113:2011-20.

Büller Hr, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(^s3):401S-28S.

Fanikos J, Piazza G, Zayaruzny M, Goldhaber SZ. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost. 2009;102:688-93.

Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(^s6):454s-545s.

van Dongen CJ, Prandoni P, Frulla M, Marchiori A, Prins MH, Hutten BA. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost. 2005;3:939-42.

Giannoukas AD, Labropoulos N, Michaels JA. Compression with or without early ambulation in the prevention of post-thrombotic syndrome. Eur J Vasc Endovasc Surg. 2006;32:217-21.

Prandoni P, Lensing AW, Prins MH. Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med. 2002;137:955-60.

Cuff RF. Screening and surveillance for deep vein thrombosis in high-risk patients. Vascular Diagnosis. 2005:463-7.

Spencer FA, Gore JM, Lessard D, Douketis JD, Emery C, Goldberg RJ. Patient outcomes after deep vein thrombosis and pulmonary embolism. Arch Intern Med. 2008;168:425-30.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5dded7f60e88258a647279a2 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections