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Residual Venous Thrombosis as a Predictive Factor of Recurrent Venous Thromboembolism

Paolo Prandoni, MD, PhD; Anthonie W.A. Lensing, MD, PhD; Martin H. Prins, MD, PhD; Enrico Bernardi, MD; Antonio Marchiori, MD; Paola Bagatella, MD; Michela Frulla, MD; Laura Mosena, MD; Daniela Tormene, MD; Andrea Piccioli, MD; Paolo Simioni, MD, PhD; and Antonio Girolami, MD
[+] Article and Author Information

From University Hospital of Padua, Padua, Italy; and University of Amsterdam, Amsterdam, and Maastricht University, Maastricht, the Netherlands.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Paolo Prandoni, MD, PhD, Department of Medical and Surgical Sciences, University of Padua, Via Ospedale Civile 105, 35128 Padua, Italy; e-mail, paoprand@tin.it.

Current Author Addresses: Drs. Prandoni, Bernardi, Marchiori, Bagatella, Frulla, Mosena, Tormene, Piccioli, Simioni, and Girolami: Department of Medical and Surgical Sciences, University of Padua, Via Ospedale Civile 105, 35128 Padua, Italy.

Dr. Lensing: Center for Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Box 22660, Amsterdam, the Netherlands.

Dr. Prins: Department of Epidemiology, Maastricht University, PO Box 5800, Maastricht, the Netherlands.

Author Contributions: Conception and design: P. Prandoni, A.W.A. Lensing.

Analysis and interpretation of the data: A.W.A. Lensing, M.H. Prins, E. Bernardi, A. Marchiori, P. Simioni.

Drafting of the article: P. Prandoni, A.W.A. Lensing, E. Bernardi, A. Marchiori, M. Frulla.

Critical revision of the article for important intellectual content: M.H. Prins, M. Frulla, D. Tormene, A. Piccioli, P. Simioni, A. Girolami.

Final approval of the article: P. Prandoni, A.W.A. Lensing, M.H. Prins, E. Bernardi, A. Marchiori, P. Bagatella, M. Frulla, L. Mosena, D. Tormene, A. Piccioli, P. Simioni, A. Girolami.

Provision of study materials or patients: P. Prandoni, P. Bagatella, M. Frulla, L. Mosena, D. Tormene, P. Simioni, A. Girolami.

Statistical expertise: A.W.A. Lensing, M.H. Prins, E. Bernardi, A. Marchiori.

Administrative, technical, or logistic support: D. Tormene, P. Simioni, A. Girolami.

Collection and assembly of data: P. Prandoni, P. Bagatella, L. Mosena, D. Tormene, A. Piccioli, P. Simioni.


Ann Intern Med. 2002;137(12):955-960. doi:10.7326/0003-4819-137-12-200212170-00008
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In the past, patients with a first episode of DVT were usually treated for a fixed period of 3 months regardless of the underlying cause (18). Currently, there is a trend toward adjusting the duration of anticoagulation according to patients' clinical characteristics at baseline. Selected patients with permanent risk factors, such as active cancer, prolonged immobilization due to chronic medical illnesses, the antiphospholipid antibody syndrome, and other thrombophilic conditions, generally receive long (and sometimes lifelong) courses of oral anticoagulant therapy (12, 19). In most patients without permanent risk factors, anticoagulation is usually withdrawn after a shorter period, ranging from 6 months to 2 years in patients with idiopathic thrombosis (4, 67, 1920) and from 6 to 12 weeks in those with transient risk factors (4, 1920). However, in all patients, the risk for recurrence after a short, fixed period of anticoagulation varies greatly. Approximately 70% of patients with unexplained thrombosis do not develop a recurrence (37, 20), and 10% of patients with transient risk factors do (35, 20). Therefore, improving our ability to identify patients who are more likely to develop a recurrence might help clinicians individually tailor the duration of anticoagulation. This, in turn, would allow a more favorable risk–benefit ratio in the use of anticoagulant treatment.

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Figures

Grahic Jump Location
Figure 1.
Flow diagram for inclusion of patients in the study.

DVT = deep venous thrombosis.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Cumulative incidence of recurrent venous thromboembolism (VTE), excluding events that occurred during the initial 3-month period.

DVT = deep venous thrombosis.

Grahic Jump Location

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Summary for Patients

Risks for Persistent Clots in Leg Veins despite Treatment

The summary below is from the full report titled “Residual Venous Thrombosis as a Predictive Factor of Recurrent Venous Thromboembolism.” It is in the 17 December 2002 issue of Annals of Internal Medicine (volume 137, pages 955-960). The authors are P Prandoni, AWA Lensing, MH Prins, E Bernardi, A Marchiori, P Bagatella, M Frulla, L Mosena, D Tormene, A Piccioli, P Simioni, and A Girolami.

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