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Venous thrombus stability during acute phase of therapy

Department of Surgery, Division of Vascular Surgery University of Washington School of Medicine, Seattle, WA

Mark H Meissner

Department of Surgery, Division of Vascular Surgery University of Washington School of Medicine, Seattle, WA

Michael J Tullis

Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM; and Light Statistical Consulting, Seattle, WA, USA

Nayak L Polissar

The Mountain-Whisper-Address for correspondence: D Eugene Strandness Jr, University of Washington, 1959 NE Pacific Street, Department of Surgery, Box 356410, Seattle, WA 98195-6410, USA

Richard A Manzo

Department of Surgery, Division of Vascular Surgery University of Washington School of Medicine, Seattle, WA

Brenda K Zierler

Department of Surgery, Division of Vascular Surgery University of Washington School of Medicine, Seattle, WA

Wayne L Chandler

Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA

D Eugene Strandness, Jr

Department of Surgery, Division of Vascular Surgery University of Washington School of Medicine, Seattle, WA

The purpose of this study was to use serial venous duplex scans to document the status of deep venous thrombi during the early phase of therapy for acute, deep-vein thrombosis (DVT). A total of 71 consecutive participants treated for a first episode of acute DVT were monitored for new venous thrombosis using serial venous duplex scans. An average of 4.6 duplex scans were performed per patient (range, three to seven) during the 3-week study period. The cumulative incidence of contiguous/non-contiguous extension of the DVT at 3 weeks was 26% (95% CI = 14% to 38%). Nine of the 15 (60%) occurrences were asymptomatic. None of the classical risk factors for DVT was significantly associated with the development of new thrombi. The fraction of time during which the level of anticoagulation was considered `adequate' (international normalized ratio >2.0 and/or heparin concentration >0.2 IU/ml) was inversely associated with the risk of extension/new thrombi (p = 0.01, Cox proportional hazards analysis).

It was concluded that: (1) the frequency of contiguous/non-contiguous extension of venous thrombosis detectable during the first 3 weeks of therapy was higher than previously reported; (2) the majority of the occurrences were asymptomatic; and (3) the risk of developing this complication was inversely associated with the level of anticoagulation achieved.

Key Words: anticoagulants • deep-vein thrombosis • extension

Vascular Medicine, Vol. 4, No. 1, 9-14 (1999)
DOI: 10.1177/1358836X9900400102


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