Symptomatic perioperative venous thromboembolism is a frequent complication in patients with a history of deep vein thrombosis

Abstract

Patients who undergo surgery are at risk for venous thromboembolism (VTE), and a history of prior deep vein thrombosis (DVT) increases that risk. This study determined the incidence and risk factors for symptomatic perioperative VTE in patients with a prior diagnosis of DVT. All lower extremity DVTs, diagnosed between January 2002 and December 2006, were identified through a vascular database. Patients who had subsequent surgery were reviewed. The following data were evaluated: location of DVT, time interval between DVT and surgery, type of surgery, common clinical VTE risk factors, postoperative venous duplex scans, computed tomography (CT) scans of the chest, and ventilation-perfusion scans. A total of 372 patients with prior DVT underwent 1081 subsequent surgical procedures. One hundred nine patients undergoing 211 procedures had a follow-up venous duplex scan within 30 days after surgery. Of them, 46% received an inferior vena caval (IVC) filter, and pulmonary emboli were diagnosed in 3 patients (<1%). Overall, 24% of the patients developed DVT extension or new-site DVT in the perioperative period. The median time interval between the original DVT and surgery was 1.5 weeks in patients with DVT recurrence and 4 weeks in patients without recurrence (P = .22, Mann-Whitney). High-risk surgeries were associated with a >three-fold increased risk for recurrence, when compared with low-risk procedures (34% vs 11%; P = .009, chi(2)). Perioperative VTE recurrence was not influenced by the location of the original thrombus or other VTE risk factors. In patients with prior DVT, perioperative symptomatic recurrence is common and is associated with high-risk procedures. A longer time interval between a DVT episode and subsequent surgery may decrease the risk of recurrence, but large clinical trials are needed to confirm this. Further prospective evaluations are needed to identify and treat patients at greatest risk for recurrence.