Abstract
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.
Highlights
Residual vein obstruction (RVO), the persistence of venous thrombosis with time and often after anticoagulation, may indicate a systemic prothrombotic condition
All abstracts were reviewed and selection was based on the following criteria: studies had to be prospective; the venous thromboembolic (VTE) should have been treated with anticoagulation for at least 4 weeks with unfractionated heparin, low molecular weight heparin, or warfarin; compression ultrasound (CUS) was performed to assess the presence of RVO; recurrent thromboembolic events at the cessation of anticoagulation were recorded
We identified 2186 potential publications from the database search from which 28 were relevant to residual vein thrombosis and had recorded data on recurrent events of venous thrombosis (Figure 1)
Summary
Residual vein obstruction (RVO), the persistence of venous thrombosis with time and often after anticoagulation, may indicate a systemic prothrombotic condition. Current markers are poor in predicting individual recurrence risk and better surrogate tests are needed [6,7,8,9,10] One such test is using the presence of residual vein obstruction (RVO), after completing the period of anticoagulation, as demonstrating increased recurrence risk. Various investigators have used different definitions for RVO [11, 12] and different studies assessing the predictability of RVO have yielded different results These disparities may be due to the heterogeneity of studies, different patient populations, and/or the varying lengths of anticoagulation. In order to better understand these results, we performed an updated metaanalysis of the published studies to determine whether RVO after a period of anticoagulation can predict VTE recurrence risk in patients with primary or secondary VTE
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