Key result
The presence of residual vein obstruction was associated with recurrent VTE events overall (OR 1.93; 95% CI 1.29-2.89) and in secondary VTE, an association likely driven by the subset with cancer.
Why the study?
Does the presence of residual vein obstruction on repeat sonography predict recurrent VTE events in patients with primary and secondary venous thrombosis?
Meta-Analysis (n=3,531)
Does the presence of residual vein obstruction on repeat sonography predict recurrent VTE events in patients with primary and secondary venous thrombosis?
Residual vein obstruction on repeat sonography predicts VTE recurrence in secondary VTE, particularly driven by patients with cancer, but not in primary VTE.
May inform recurrence risk stratification in cancer-associated VTE; leaves open utility in primary VTE and for guiding therapy.
Background. Residual vein obstruction (RVO), the persistence of venous thrombosis with time and often after anticoagulation, may indicate a systemic prothrombotic condition. Prior studies have shown varying efficacy in using RVO as a risk factor for future venous thromboembolic (VTE) recurrence. Methods. To assess whether positive RVO imaging predicts recurrent VTE events, we performed a meta-analysis on studies in which patients with documented VTEs, anticoagulated for a minimum of 4 weeks, had repeat sonography to assess RVO and were subsequently followed for recurrent events. Results. Thirteen studies met inclusion criteria: 3531 patient VTE events with 3474 evaluable results were analyzed. The presence of RVO was associated with recurrence in all VTE (OR 1.93; 95% CI: 1.29, 2.89) and secondary VTE (OR 2.78; 95% CI: 1.41, 5.5) but not for primary VTE (OR 1.35; 95% CI: 0.87, 2.08). When cancer patients were eliminated from the secondary VTE group, there was no longer a significant association of RVO with VTE recurrence (OR 1.73; 95% CI: 0.81, 3.67) while in the subset of cancer patients, presence of RVO was associated with an increase in VTE recurrence risk (OR 5.14; 95% CI: 1.59, 16.65, P < 0.006). Conclusions. We conclude that the presence of RVO is associated with recurrence in secondary VTE but not in primary VTE and that association may be driven by the subset with cancer.
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Janakiram et al. (2013) conducted a meta-analysis in Venous Thrombosis (n=3,531). Residual vein obstruction (RVO) vs. Absence of RVO was evaluated on Recurrent VTE events (OR 1.93, 95% CI 1.29, 2.89). The presence of residual vein obstruction was associated with recurrent VTE events overall (OR 1.93; 95% CI 1.29-2.89) and in secondary VTE, an association likely driven by the subset with cancer.
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