Clinical outcomes of a management strategy consisting of tailored anticoagulant treatment based on residual vein thrombosis: contemporary data

M. Nagler1, H. ten Cate2,3, M. Prins2, A. ten Cate-Hoek2 (1Bern, Switzerland, 2Maastricht, The Netherlands, 3Maastricht , The Netherlands)

Venous Thrombosis
Date: 17.02.2017,
Time: 08:00 - 09:15

Objective: Finding the optimal duration of anticoagulant treatment following an acute event of deep venous thrombosis (DVT) is challenging. Residual thrombosis has been identified as risk factor for recurrence, but data on management strategies based on residual thrombosis and associated recurrence rates in defined clinical care pathways (CCP) are lacking.

Methods: All patients treated at Maastricht University Medical Center within an established clinical care pathway from June 2003 through June 2013 were prospectively followed for up to 11 years. Treatment duration was tailored based on residual vein thrombosis. Recurrence rates were determined. A cox proportional hazards model employing anticoagulation treatment as time-varying covariate was used to define risk factors for recurrence.

Results: Out of 479 patients diagnosed with proximal DVT, 474 completed the two-year CCP (99%), and 457 (94.7%) the extended follow-up (2231.2 patient-years; median follow-up 4.6 years; median age 58.0 years; 50.4% females). Overall VTE recurrence was 2.9 per 100 patient-years, 1.3 if provoked by surgery, 2.1 if a non-surgical transient risk factor was present, and 4.0 if unprovoked. Residual thrombosis was present in 141 patients (29.8%). Duration of anticoagulation was 3 months in 75 patients (15.8%), 6 months in 230 (48.1%), 12 months in 95 (20.1%) and indefinite in 76 (16%). Significant predictors of recurrent events were unprovoked VTE (hazard ratio [HR] 4.6; 95% CI 1.7, 11.9), elevated d-dimers one month after stop treatment (HR 3.3; 1.8, 6.1), male sex (HR 2.8; 1.5, 5.1), high factor VIII (HR 2.0; 1.1, 3.7) and use of contraceptives (HR 0.1; 0.0, 0.9).

Conclusion: Patients with DVT managed within an established clinical care pathway according to the presence of residual vein thrombosis had low incidences of VTE recurrence. In accordance with other clinical settings, unprovoked VTE, male sex, elevated D-dimers one month after stop treatment, inflammation, and high FVIII were identified as major predictors for recurrent VTE.