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Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry

2016; Elsevier BV; Volume: 5; Issue: 1 Linguagem: Inglês

10.1016/j.jvsv.2016.08.002

2213-3348

Daniel H. Newton, Manuel Monreal Bosch, Michael Amendola, Luke G. Wolfe, Cristina Pérez Ductor, Ramón Lecumberri, Mark Levy, Manuel Monréal, Hervé Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Inna Tzoran, Abílio Reis, Marijan Bosevski, Henri Bounameaux, Radován Malý, Philip Wells, Manolis Papadakis, Ramón Agüero, Miguel Ángel Aibar Arregui, María Alfonso, Ramón Aranda, Juan I. Arcelus, Raquel Barba, M. Barrón, B. Barrón‐Andrés, José Bascuñana, J. Binetti, Á. Blanco-Molina, Tulio Bueso, I. Cañas, Fábio Carmona, N. Chic, Alex Culla, Roberto del Pozo, J. del Toro, Carmen Díaz‐Pedroche, J.A. Díaz‐Peromingo, C. Falgá, C. Fernández‐Aracil, Carmen Fernández‐Capitán, M.A. Fidalgo, Carme Font, Llorenç Font, P. Gallego, Marian García-Núñez, F. García‐Bragado, Vicente Gómez del Olmo, J. González, E Grau, A. Grimón, L. Guirado, Juan Mata, G. Hernández-Comes, Luis Blasco, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, M.D. Joya, Ramón Lecumberri, J.L. Lobo, Luciano López-Jiménez, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, I. Manrique-Abos, Pablo Javier Marchena, Miren Martín García, J.M. Martín‐Antorán, F. Martín‐Martos, Manuel Monréal, José Antonio Nieto, Santiago Nieto, Antonio Rodrı́guez-Núñez, Manuel Jesús Núñez, S. Otálora, Remedios Otero, B. Pagán, José María Pedrajas, Gustavo Pérez, Ignacio Sánchez Pérez, C. Pérez‐Ductor, M.L. Peris, José Antonio Porras, Òscar Reig, Antoni Riera‐Mestre, David Riesco, A. Rivas, M.A. Rodríguez‐Dávila, V. Rosa, E. Rosillo-Hernández, Pedro Ruiz‐Artacho, N. Ruiz‐Giménez, Joan Carles Sahuquillo, M.C. Sala‐Sainz, A. Sampériz, Rosario Sánchez‐Martínez, O. Sanz, S. Soler, B. Sopeña, José María Suriñach, Carles Tolosa, Javier Trujillo‐Santos, Fernando Uresandi, B. Valero, R. Valle, J. Vela, G. Vidal, J Villalta, Thomas Vanassche, Peter Verhamme, Philip Wells, Jana Hirmerová, Radován Malý, E. Salgado, Laurent Bertoletti, A. Bura-Rivière, K. Champion, Dominique Farge, A. Hij, Isabelle Mahé, A. Merah, Marios Papadakis, Andrei Braester, Benjamin Brenner, Inna Tzoran, G. Antonucci, Giovanni Barillari, Franca Bilora, Maurizio Ciammaichella, Francesco Dentali, P. Di Micco, R. Duce, Paola Ferrazzi, Elvira Grandone, Corrado Lodigiani, R. Maida, F. Pace, Raffaele Pesavento, Renzo Poggio, Paolo Prandoni, L. Rota, Eros Tiraferri, D. Tonello, Antonella Tufano, A. Visonà, Beniamino Zalunardo, Eva Dručka, Dana Kigitoviča, Andris Skride, Ascensión Ramos, José Luís Pais Ribeiro, Mariana S. Sousa, Marijan Bosevski, Marija Zdraveska, Henri Bounameaux, Andrea Erdmann, Lucia Mazzolai, B. Ney,

Diagnosis and Treatment of Venous Diseases

Objective We sought to determine the risk factors for subsequent bleeding and recurrent venous thromboembolism (VTE) events following isolated noncatheter-associated upper extremity deep venous thrombosis (non-CA-UEDVT) to better inform future treatment decisions for this group of patients. Methods The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of patients with objectively confirmed symptomatic VTE. Patients with a symptomatic, isolated, proximal UEDVT from March 2001 through March 2015 were analyzed. Any patient with an indwelling catheter or pacemaker lead at the DVT site and at the time of thrombosis was considered to have a CA-UEDVT and was excluded. Patient and treatment characteristics such as age, gender, comorbidities, VTE risk factors, treatment drug, and duration were collected. Outcomes examined included recurrent DVT, subsequent pulmonary embolism (PE), and hemorrhage. Multivariate analysis was performed using stepwise logistic regression. Results Of the 1100 patients who met the study criteria, 580 (53%) were male. The mean age of the patients was 50 ± 20 years, and overall patient survival at 1 year was 85%. Recurrent VTE occurred in 59 patients (5.4%). Of these, 46 patients (4%) had recurrent DVT, 10 (0.9%) had a PE following UEDVT diagnosis, and 3 (0.3%) had both. PE was fatal in three patients (0.3%). Bleeding occurred in 50 patients (4.5%), major bleeding in 19 patients (1.7%), and fatal bleeding in 6 patients (0.5%). On multivariate analysis, malignant disease was associated with VTE recurrence (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.04-3.45; P < .04), whereas hemorrhage was associated with age (OR, 1.03; 95% CI, 1.01-1.05; P = .002) and malignant disease (OR, 2.53; 95% CI, 1.34-4.76; P < .005). Hemorrhage and recurrent VTE were also significantly associated (OR, 2.79; 95% CI, 1.16-6.76; P < .03). Conclusions PE following non-CA-UEDVT is rare. Malignant disease was associated with VTE recurrence. Age and malignant disease were associated with hemorrhage, and VTE recurrence was associated with hemorrhage. Further prospective studies should be undertaken to best determine length of anticoagulation treatment for the varied populations of patients with UEDVT.