Matias E. Valsecchi, MD
Potential Conflicts of Interest: None disclosed.
Valsecchi M.; Risk for Venous Thromboembolism in Patients With Superficial Venous Thrombosis. Ann Intern Med. 2010;153:63. doi: 10.7326/0003-4819-153-1-201007060-00025
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Published: Ann Intern Med. 2010;153(1):63.
TO THE EDITOR:
I found the article by Decousus and colleagues (1) very interesting in relation to the apparently not-so-benign course of symptomatic SVT. This study adds more evidence for the need to screen for DVT in patients with SVT and raises valid questions about the potential benefit of systemic anticoagulation. However, this is known to be a heterogenic population, and patients who will definitely benefit from full anticoagulation are those with thrombophilic disorders. It is striking that even though Decousus and colleagues describe only 5% of known biological thrombophilia, in patients who had only isolated SVT at diagnosis, more than 50% (348 of 634) had a history of SVT, DVT, or pulmonary embolism. That proportion increases to 87% (554 of 634) if we also include positive family history. These numbers, together with the fact that some previous studies (2, 3) showed a higher-than-expected prevalence of thrombophilic states in patients with SVT, raise the question of whether some of these patients might have had a basal hypercoagulable state. It would be particularly interesting to know if those patients who had only SVT but developed thrombotic complications over the following 3 months were tested for known hypercoagulable disorders. It is unclear whether screening for those disorders is cost-effective in patients with SVT. Information retrieved from a prospective clinical trial, such as this one, could have significant value.
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