Annual diagnosis rate of superficial vein thrombosis of the lower limbs: the STEPH community‐based study
2014; Elsevier BV; Volume: 12; Issue: 6 Linguagem: Inglês
10.1111/jth.12575
ISSN1538-7933
AutoresPaul Frappé, Andréa Buchmüller-Cordier, Laurent Bertoletti, Claire Bonithon‐Kopp, S. Couzan, P Lafond, Alain Leizorovicz, A. Merah, Émilie Presles, P Preynat, Bernard Tardy, Hervé Decousus,
Tópico(s)Central Venous Catheters and Hemodialysis
ResumoJournal of Thrombosis and HaemostasisVolume 12, Issue 6 p. 831-838 Original ArticleFree Access Annual diagnosis rate of superficial vein thrombosis of the lower limbs: the STEPH community-based study Correction(s) for this article Erratum Volume 13Issue 8Journal of Thrombosis and Haemostasis pages: 1538-1538 First Published online: June 12, 2015 P. Frappé, P. Frappé INSERM, CIE3, Saint-Etienne, France Département de Médecine Générale, Université Jean Monnet, Saint-Etienne, France EA3065, Université Jean Monnet, PRES de Lyon, Saint-Etienne, FranceSearch for more papers by this authorA. Buchmuller-Cordier, A. Buchmuller-Cordier INSERM, CIE3, Saint-Etienne, France Service de Médecine et Thérapeutique, CHU de Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorL. Bertoletti, L. Bertoletti INSERM, CIE3, Saint-Etienne, France EA3065, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France Service de Médecine et Thérapeutique, CHU de Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorC. Bonithon-Kopp, C. Bonithon-Kopp CIC-Epidémiologie clinique INSERM CIE1, Faculté de Médecine, Dijon, FranceSearch for more papers by this authorS. Couzan, S. Couzan Association Régionale de Médecine Vasculaire Rhône-Alpes, Saint-Etienne, FranceSearch for more papers by this authorP. Lafond, P. Lafond Service Urgence et SAMU, CHU de Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorA. Leizorovicz, A. Leizorovicz UMR 5558, Faculté RTH Laënnec, Lyon 1, FranceSearch for more papers by this authorA. Merah, A. Merah INSERM, CIE3, Saint-Etienne, FranceSearch for more papers by this authorE. Presles, E. Presles INSERM, CIE3, Saint-Etienne, FranceSearch for more papers by this authorP. Preynat, P. Preynat Association Régionale de Médecine Vasculaire Rhône-Alpes, Saint-Etienne, FranceSearch for more papers by this authorB. Tardy, B. Tardy INSERM, CIE3, Saint-Etienne, France EA3065, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France Service Urgence et SAMU, CHU de Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorH. Décousus, Corresponding Author H. Décousus INSERM, CIE3, Saint-Etienne, France EA3065, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France Service de Médecine et Thérapeutique, CHU de Saint-Etienne, Saint-Etienne, France Correspondence: Hervé Décousus, CIC-EC INSERM, CIE3, Hôpital Nord, CHU de Saint-Etienne, 42055 Saint Etienne Cedex 2, France. Tel.: +33 4 77 42 76 37; fax: +33 4 77 12 78 20. E-mail: herve.decousus@chu-st-etienne.frSearch for more papers by this authorfor the STEPH Study Group, the STEPH Study GroupSee Appendix for full list of contributors.Search for more papers by this author P. Frappé, P. Frappé INSERM, CIE3, Saint-Etienne, France Département de Médecine Générale, Université Jean Monnet, Saint-Etienne, France EA3065, Université Jean Monnet, PRES de Lyon, Saint-Etienne, FranceSearch for more papers by this authorA. Buchmuller-Cordier, A. Buchmuller-Cordier INSERM, CIE3, Saint-Etienne, France Service de Médecine et Thérapeutique, CHU de Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorL. Bertoletti, L. Bertoletti INSERM, CIE3, Saint-Etienne, France EA3065, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France Service de Médecine et Thérapeutique, CHU de Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorC. Bonithon-Kopp, C. Bonithon-Kopp CIC-Epidémiologie clinique INSERM CIE1, Faculté de Médecine, Dijon, FranceSearch for more papers by this authorS. Couzan, S. Couzan Association Régionale de Médecine Vasculaire Rhône-Alpes, Saint-Etienne, FranceSearch for more papers by this authorP. Lafond, P. Lafond Service Urgence et SAMU, CHU de Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorA. Leizorovicz, A. Leizorovicz UMR 5558, Faculté RTH Laënnec, Lyon 1, FranceSearch for more papers by this authorA. Merah, A. Merah INSERM, CIE3, Saint-Etienne, FranceSearch for more papers by this authorE. Presles, E. Presles INSERM, CIE3, Saint-Etienne, FranceSearch for more papers by this authorP. Preynat, P. Preynat Association Régionale de Médecine Vasculaire Rhône-Alpes, Saint-Etienne, FranceSearch for more papers by this authorB. Tardy, B. Tardy INSERM, CIE3, Saint-Etienne, France EA3065, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France Service Urgence et SAMU, CHU de Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorH. Décousus, Corresponding Author H. Décousus INSERM, CIE3, Saint-Etienne, France EA3065, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France Service de Médecine et Thérapeutique, CHU de Saint-Etienne, Saint-Etienne, France Correspondence: Hervé Décousus, CIC-EC INSERM, CIE3, Hôpital Nord, CHU de Saint-Etienne, 42055 Saint Etienne Cedex 2, France. Tel.: +33 4 77 42 76 37; fax: +33 4 77 12 78 20. E-mail: herve.decousus@chu-st-etienne.frSearch for more papers by this authorfor the STEPH Study Group, the STEPH Study GroupSee Appendix for full list of contributors.Search for more papers by this author First published: 28 March 2014 https://doi.org/10.1111/jth.12575Citations: 53 Manuscript handled by: F. R. Rosendaal Final decision: F. R. Rosendaal, 22 March 2014 Clinical Trial Registration: ClinicalTrials.gov NCT01501175 AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Summary Background The incidence of superficial vein thrombosis (SVT) in the general adult population remains unknown. Objectives To assess the annual diagnosis rate of symptomatic, objectively confirmed lower limb SVT, associated or not with concomitant deep vein thrombosis and/or symptomatic pulmonary embolism. Methods/patients We conducted, from November 14, 2011, to November 13, 2012, a multicenter, community-based study in the Saint-Etienne urban area, France, representing a population of 265 687 adult residents (according to the 2009 census). All 248 general practitioners located within the area were asked to refer any patient with clinically suspected lower limb acute SVT to a vascular physician for systematic compression ultrasonography. All 28 vascular physicians located within the area participated in the study. The annual diagnosis rate, with the corresponding 95% confidence interval (CI), was calculated as the number of patients with symptomatic, objectively confirmed SVT divided by the number of person-years at risk defined by population data of the area. All venous thromboembolic events were validated by an independent central adjudication committee. Results Overall, 171 patients with symptomatic, confirmed SVT were reported. The annual diagnosis rate was 0.64% (95% CI, 0.55%–0.74%), was higher in women, and increased with advancing age regardless of gender. Concomitant deep vein thrombosis (20 proximal) was observed in 42 patients (24.6% [95% CI, 18.3%–31.7%]), and concomitant symptomatic pulmonary embolism was observed in eight patients (4.7% [95% CI, 2.0%–9.0%]). Conclusions This first community-based study showed that symptomatic SVT with confirmed diagnosis is a relatively common disease frequently associated with thromboembolic events in the deep venous system. Introduction Recent epidemiological studies conducted in the secondary or tertiary care setting have shown that superficial vein thrombosis (SVT) is a potentially serious disease 1, 2. In one of these studies, 25% of patients had, at first presentation, concomitant associated symptomatic or asymptomatic deep vein thrombosis (DVT; with 39% being proximal), and 4% had an associated symptomatic pulmonary embolism (PE) 1, suggesting that systematic compression ultrasonography should be performed in all patients with suspected SVT 3-5. Moreover, when SVT was isolated (i.e., without concomitant DVT or PE at first presentation), up to 8% of patients developed symptomatic thromboembolic complications within 3 months 1. The incidences of DVT and PE in the general population have been assessed in several epidemiological studies 6-10. DVT is reported to affect approximately 0.5%–1.2‰ persons per year and PE to affect 0.3%–0.6%, with these incidences rising exponentially with advancing age 6-10. In contrast, the incidence of SVT has never been measured prospectively, despite being estimated to occur more often than DVT 4, 11-13. Finally, the few available prospective epidemiological studies on SVT were conducted solely in the secondary or tertiary care setting 1, 2. SVT is a condition frequently disregarded by patients and primary care practitioners. As a consequence, its true incidence in the general population is difficult to assess. We therefore conducted a descriptive, multicenter, community-based study to evaluate the annual diagnosis rate of symptomatic SVT of the lower limbs in a primary care setting within a well-defined geographic area. The secondary objective was to assess the proportion of SVT cases with concomitant DVT and/or symptomatic PE at presentation. Methods The STEPH study was a descriptive, multicenter, community-based study conducted during a 1-year period in the resident adult population of the Greater Saint-Etienne urban area (France). Patient recruitment Patients were all hospitalized or non-hospitalized inhabitants of the study area, aged ≥ 18 years, in whom acute symptomatic SVT was diagnosed and confirmed ultrasonographically between November 14, 2011, and November 13, 2012. They were identified from several sources, including mainly primary care practitioners but also secondary/tertiary physicians from both private and public practices located in the study area. In France, and particularly in the Greater Saint-Etienne urban area, venous compression ultrasonographic examinations are performed by vascular physicians. Several measures were taken to ensure, as far as possible, the exhaustiveness of case reporting. First, the geographic area studied was precisely predefined as the city of Saint-Etienne and the 10 surrounding cantons. This area encompasses 32 towns and 334 952 inhabitants, including 265 687 adults 14. Social Security data confirmed that these inhabitants consult general practitioners located within the same area 15. Before the start of the study, an article was published in the local newspaper to inform the population of its launch. Second, all the 248 general practitioners working in the predefined area were asked via letter to refer any patient with clinically suspected SVT to a vascular physician for compression ultrasonography and to sign an agreement committing themselves to doing so systematically. All the 28 vascular physicians in the predefined area, including those practicing in a hospital, participated in the study. Third, a total of seven local kick-off meetings were held with the general practitioners and vascular physicians working in the study area to inform them about the latest research findings concerning SVT and the study objectives and logistics. During these meetings, no specific standardized criteria for referral were proposed to participating physicians, to keep the study procedures as close as possible to routine practice; general practitioners were asked to refer any clinical suspicion of SVT to a vascular physician, regardless of their level of confidence in this suspicion. Throughout the study, newsletters were sent regularly to maintain the investigators' motivation. Fourth, the reasons for any patient exclusion were to be documented. Finally, the exhaustiveness of inclusions was further ensured by implementing a cross-checking process between general practitioners and vascular physicians for inclusions and, for hospitalized patients, by systematically checking coded reasons for hospitalization based on the World Health Organization International Statistical Classification of Diseases and Related Health Problems 10th Revision 16. The study was conducted in accordance with the ethical principles stated in the Declaration of Helsinki, Good Clinical Practice, and relevant French legal and regulatory requirements regarding data protection. The protocol was approved by an independent ethics committee. All patients received written information about the study, emphasizing their right to refuse participation or to withdraw at any time. No written informed consent was required for inclusion. Data collection All patients consulting a general practitioner for a clinical suspicion of SVT of the lower limbs had to be systematically referred to a vascular physician for compression ultrasonography. Patients were prospectively included in the study by vascular physicians regardless of the nature of the primary consultation (general practitioner, emergency unit, or other hospital department), as soon as the diagnosis was confirmed with compression ultrasonography. Reporting of negative ultrasound tests was not requested. Clinical data, including the patient's place of residence, demographic characteristics, and risk factors for venous thromboembolism, were collected by the vascular physician. Symptoms and signs of PE were systematically sought by the vascular physician, and, if suspected, the diagnosis had to be objectively confirmed. Data were entered in the study database using a standardized electronic case report form (CleanWEB™; http://cleanweb.tentelemed.com). All data regarding venous thromboembolic events were checked on-site against source documents by a dedicated clinical research associate. Outcome validation SVT and DVT were diagnosed with the use of complete bilateral compression ultrasonography and categorized as ‘at or above knee’ or ‘below knee’ for SVT (when appropriate) and as ‘proximal’ or ‘distal’ for DVT. The ultrasonographic criteria used for the diagnosis of SVT were similar to those used in a previous study 17 with the exception that no minimal thrombus length was specified. DVT was stated to be proximal if incompressibility was noted with respect to the popliteal, superficial femoral, common femoral or iliac vein, or vena cava. All compression ultrasonography examinations were performed according to a predefined procedure, standardized across all centers, similar to that used previously 17, 18. Clinically suspected concomitant PE had to be confirmed with spiral computed tomography or high-probability ventilation-perfusion lung scanning. Based on these data, including ultrasonographic images and specific reports of objective tests, all suspected thromboembolic events, whether or not objectively confirmed, were reviewed by an independent central adjudication committee in accordance with published validated criteria for SVT 1, 17 and international guideline criteria for DVT and PE 19, 20. Statistical analysis Population data by age group and gender were provided by the most recent census, that of 2009, and were used to estimate the number of person-years at risk during the study period. The annual diagnosis rate (per thousand), with the corresponding 95% confidence interval (CI), was calculated by 10-year group as the number of patients with confirmed SVT occurring during the year of the study divided by the number of person-years, assuming a normal distribution. To permit comparison with other studies, annual diagnosis rates were age-standardized by the direct method using the World Health Organization European standard population 21. The proportion of cases associated with concomitant DVT or PE at presentation was calculated. Except for annual diagnosis rates, qualitative data were reported as numbers and percentages. Quantitative data were reported as median and interquartile range. SAS-Windows® version 9.3 (SAS Institute, Cary, NC, USA) was used to analyze and process all data. Results The study was conducted from November 14, 2011, to November 13, 2012. During the study year, 171 patients were diagnosed with SVT. All cases were confirmed with compression ultrasonography and adjudicated as such by the Central Adjudication Committee. Thus, the measured annual diagnosis rate of SVT was 0.64% [95% CI, 0.55%–0.74%]. The age-standardized rate was 0.53% [95% CI, 0.41%–0.64%]. Annual diagnosis rates varied widely according to age and sex, from 0.04% [95% CI, 0.00%–0.10%] in men aged 18–39 years to 2.19% [95% CI, 1.59%–2.78%] in women aged ≥ 75 years (Table 1 and Fig. 1). Table 1. Annual diagnosis rates of superficial vein thrombosis by age and sex Age group, y Person-years, n Patients, n Annual diagnosis rates, % (95% CI) Female residents 18–39 47 978 6 0.13 (0.02–0.23) 40–59 44 215 23 0.52 (0.31–0.73) 60–74 26 353 30 1.14 (0.73–1.55) ≥ 75 23 784 52 2.19 (1.59–2.78) Subtotal 142 330 111 0.78 (0.63–0.92) Male residents 18–39 47 962 2 0.04 (0.00–0.10) 40–59 40 463 27 0.67 (0.42–0.92) 60–74 22 252 19 0.85 (0.47–1.24) ≥ 75 12 680 12 0.95 (0.41–1.48) Subtotal 123 357 60 0.49 (0.36–0.61) CI, confidence interval. Figure 1Open in figure viewerPowerPoint Annual diagnosis rates by age and sex (per 1000 residents). Among the 168 cases of confirmed SVT for which referral information is available, 155 (92.3%) were referred to a vascular physician by a primary care physician (Table 2). Of these cases, 114 were referred by a general practitioner located within the study area. No differences in patient characteristics were seen according to whether the patients had been referred by general practitioners who had signed (n = 117) or not signed (n = 131) an agreement to participate in the study (data not shown). The median intervals between symptom onset and the first consultation and between symptom onset and consultation with the vascular physician were 5 days (interquartile range, 3–9 days) and 6 days (interquartile range, 4–11 days), respectively. Table 2. First physician consulted by patients with confirmed superficial vein thrombosis Total No. of patients (N = 168)* *Data missing in three cases. †General practitioners with a specific practice (e.g., allergology, acupuncture), general practitioners outside the study area referring patients living within the study area, or general practitioners newly establishing a practice in the study area during the study period. Primary care General practitioner in the study area 114 (67.9) Having signed an agreement to participate in the study (n = 117) 66 Not having signed such an agreement (n = 131) 48 After-hours/emergency unit 17 (10.1) Other primary care physician† *Data missing in three cases. †General practitioners with a specific practice (e.g., allergology, acupuncture), general practitioners outside the study area referring patients living within the study area, or general practitioners newly establishing a practice in the study area during the study period. (n = 19) 24 (14.3) Secondary/tertiary care Vascular physician, hospital 9 (5.4) Vascular physician, private practice 2 (1.2) Other 2 (1.2) *Data missing in three cases. †General practitioners with a specific practice (e.g., allergology, acupuncture), general practitioners outside the study area referring patients living within the study area, or general practitioners newly establishing a practice in the study area during the study period. SVT involved the long saphenous vein in 90 (52.6%) cases, the short saphenous vein in 22 cases (12.9%), and other superficial veins in 100 cases (58.5%), with the total being > 100% because patients could have experienced SVT at more than one site (Table 3). It was associated with concomitant DVT and/or symptomatic PE at inclusion in 45 cases (26.3% [95% CI, 19.9%–33.6%]), a concomitant DVT being diagnosed in 42 cases (24.6%, 95% CI, 18.3%–31.7%), proximal in 20 (47.6%) of 42 cases, and a concomitant symptomatic PE in eight cases (4.7%, 95% CI, 2.04%–9.01%), all confirmed with spiral computed tomography (Table 3). The concomitant DVT was not contiguous to the SVT in 19 (45.2%) of 42 cases. Table 3. Characteristics of venous thromboembolic events Characteristics SVT with DVT or PE (n = 45) SVT without DVT or PE (n = 126) All SVT (N = 171) SVT Median (IQR) time between symptom onset and first consultation, d 4.0 (3.0–9.0) 5.0 (4.0–9.5) 5.0 (3.0–9.0) Median (IQR) time between symptom onset and first consultation with a vascular physician, d 5.0 (3.0–11.0) 6.0 (4.0–11.0) 6.0 (4.0–11.0) Long saphenous vein* IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. 29 (64.4) 61 (48.4) 90 (52.6) At or above knee 22 (48.9) 35 (27.8) 57 (33.3) Short saphenous vein* IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. 8 (17.8) 14 (11.1) 22 (12.9) Other superficial veins* IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. † IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. 20 (44.4) 80 (63.5) 100 (58.5) Extension to perforating veins‡ IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. 17 (37.8) 3 (2.4)† IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. 20 (11.8) DVT or PE§ IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. 45 (100.0) – 45 (26.3) DVT§ IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. 42 (93.3) – 42 (24.6) Proximal 20 (44.4) – 20 (11.7) Distal 23 (51.1) – 23 (13.5) Symptomatic PE§ IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. 8 (17.8) – 8 (4.7) IQR, interquartile range; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Patients could have experienced SVT at more than one site. †Including tributaries of the long and short saphenous veins. ‡Data missing in one patient. §Concomitant with SVT. The median age of the 171 patients with confirmed SVT was 68 years (interquartile range, 56–79 years), 37 patients (25.3%) were obese, 111 (64.9%) were women, 130 (82.8%) had varicose veins, and 77 (47.0%) had a personal history of venous thromboembolism (Table 4). In patients with concomitant DVT or PE at presentation, SVT was more frequently located in the great saphenous vein, at or above the knee, and extended to the perforating veins than in patients without such complications (Table 3). Table 4. Characteristics of patients with confirmed SVT Variable Total (N = 171)* IQR, interquartile range; VTE, venous thromboembolism; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Denominators may be < 171 due to missing data for some variables. †Cancer treatment ongoing or received within the past 6 months. ‡Estrogens or progestogens. Median (IQR) age, y 68 (56.0–79.0) Age > 75 y, No. (%) 58 (33.9) Women, No. (%) 111 (64.9) Median (IQR) body mass index, kg m−2 25.6 (23.3–30.1) Body mass index > 30 kg m−2, No. (%) 37 (25.3) Risk factors for VTE, No. (%) Varicose veins 130 (82.8) Personal history of VTE 77 (47.0) SVT 51 (32.1) DVT 45 (27.3) PE 20 (12.4) Family history of VTE 36 (26.7) SVT 12 (9.4) DVT 30 (22.1) PE 13 (9.5) Immobility Recent travel (within past 20 days) 20 (12.2) Current hospitalization 11 (6.7) Bed rest (> 3 days, within past 20 days) 9 (5.6) Trauma (within past 30 days) 9 (5.6) Recent surgery (within past 60 days) 6 (3.7) Lower limb immobilization 0 (0.0) Acute infectious disease (within past 30 days) 13 (8.0) Active cancer† IQR, interquartile range; VTE, venous thromboembolism; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Denominators may be < 171 due to missing data for some variables. †Cancer treatment ongoing or received within the past 6 months. ‡Estrogens or progestogens. 13 (7.9) Autoimmune disease 7 (4.3) Endocrine Oral contraceptive use 5 (4.7) Pregnancy or postpartum 4 (3.8) Hormone-replacement therapy‡ IQR, interquartile range; VTE, venous thromboembolism; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Denominators may be < 171 due to missing data for some variables. †Cancer treatment ongoing or received within the past 6 months. ‡Estrogens or progestogens. 0 (0.0) IQR, interquartile range; VTE, venous thromboembolism; SVT, superficial vein thrombosis; DVT, deep vein thrombosis; PE, pulmonary embolism. *Denominators may be < 171 due to missing data for some variables. †Cancer treatment ongoing or received within the past 6 months. ‡Estrogens or progestogens. Discussion This first community-based study on the annual diagnosis rate of symptomatic lower limb SVT showed that this disease is frequent (0.64% per year in an adult population). Annual diagnosis rates appeared to be higher in women than in men and to increase substantially with advancing age, as reported for DVT and PE 6-10. Our results confirm a high rate of concomitant DVT and/or PE at first presentation in patients with SVT 1, 2, even in the primary care setting (24.6% and 4.7%, respectively). Surprisingly, the annual diagnosis rate of SVT appears to be lower than the annual diagnosis rate of DVT. In the only other community-based study on SVT performed to date, the prevalence of this disease was found to be approximately twice that of DVT and/or PE 11. In that study, however, the data were based on historical information reported by the patient and were not checked in any way, which may explain why they differ from our findings. The methodology of studies investigating the incidence of DVT and PE varies widely 6-8. In a French study conducted in 1999 and using methods comparable to ours, the annual incidence of lower limb DVT was 1.24% and that of PE was 0.6% 6. Thus, the annual diagnosis rate of SVT in the primary care setting appears to be half that of DVT and close to that of PE. Two French epidemiological studies on SVT were conducted in the secondary/tertiary care setting (i.e., patients were recruited only by vascular physicians) 1, 2. These studies showed that SVT is a potentially serious disease, with one fourth to one third of the patients included manifesting concomitant DVT or PE at first presentation. In our study, conducted in the primary care setting, 92.3% of the patients were first seen by a primary care physician and were then referred to a vascular physician. Thus, our patient population might have been expected to be less severely ill than those included in the two previous e
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