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Superficial Venous Thrombosis and Venous Thromboembolism: A Large, Prospective Epidemiologic Study

Hervé Decousus, MD; Isabelle Quéré, MD; Emilie Presles, MD; François Becker, MD; Marie-Thérèse Barrellier, MD; Myriam Chanut, MD; Jean-Luc Gillet, MD; Hervé Guenneguez, MD; Christine Leandri, MD; Patrick Mismetti, MD, PhD; Olivier Pichot, MD; Alain Leizorovicz, MD, POST (Prospective Observational Superficial Thrombophlebitis) Study Group
[+] Article and Author Information

For a list of participating committees and investigators, see the Appendix.


From University Hospital, Saint-Étienne, France; Saint Eloi University Hospital, Montpellier, France; University Hospital, Geneva, Switzerland; University Hospital, Caen, France; Vascular Medicine, Aubenas, France; Vascular Medicine, Bourgoin-Jailleu, France; Mégival Clinic, Saint-Aubin-sur-Scie, France; Vascular Medicine, Annonay, France; Vascular Medicine, Grenoble, France; and UMR 5558, Lyon, France.


Note: This work was presented as 2 abstracts at the Congress of the International Society of Thrombosis and Haemostasis, Geneva, Switzerland, 6–12 July 2007 (J Thromb Haemost. 2007;5 (supp 1):abstracts O-S-OR9 and P-S 600).

Acknowledgment: The authors thank Zohra Akkal for her assistance in coordinating the study.

Grant Support: By GlaxoSmithKline, sanofi-aventis, the Ministère Français de la Santé et des Sports (Programme Hospitalier de Recherche Clinique), the Société Française de Médecine Vasculaire, and the Société Française de Phlébologie.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-0686.

Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Decousus (e-mail, herve.decousus@chu-st-etienne.fr)

Requests for Single Reprints: Hervé Decousus, MD, Service de Médecine et Thérapeutique, Groupe de recherche sur la thrombose (EA 3065), Centre d'Investigation Clinique CIE3 (INSERM/DHOS), Hôpital Nord, CHU Saint-Étienne, 42055 Saint-Étienne Cedex, France.

Current Author Addresses: Dr. Decousus: Service de Médecine et Thérapeutique, Hôpital Nord, Bâtiment A, Niveau 0, 42055 Saint-Étienne Cedex 2, France.

Dr. Quéré: CHU de Montpellier, Service des Maladies Vasculaires, Hôpital Saint-Eloi, 80 rue Fliche, 34295 Montpellier Cedex 5, France.

Dr. Presles: CHU de Saint-Etienne, Bâtiment Recherche, Hôpital Nord, 42055 Saint-Étienne Cedex 2, France.

Dr. Becker: 40 chemin Favrands, 74400 Chamonix, France.

Dr. Barrellier: Laboratoire des Explorations Fonctionnelles, Niveau 01, CHU Côte de Nacre, 14033 Caen Cedex, France.

Dr. Chanut: Médecine Vasculaire, Le Clos de Bellande, Rue Denis Papin, 07200 Aubenas, France.

Dr. Gillet: Médecine Vasculaire, 51 Bis avenue Professeur Tixier, 38300 Bourgoin-Jaillieu, France.

Dr. Guenneguez: Clinique Megival, 1328 avenue Maison Blanche, 76550 Saint-Aubin-sur-Scie, France.

Dr. Leandri: Médecine Vasculaire, Les Domaines de la Gare, 07100 Annonay, France.

Dr. Mismetti: URCIP, Bâtiment Recherche, Hôpital Nord, 2055 Saint-Étienne Cedex 2, France.

Dr. Pichot: Centre de Médecine Vasculaire, 7 rue Lesdiguières, 38000 Grenoble, France.

Dr. Leizorovicz: Service de Pharmacologie Clinique, Faculté Laënnec, rue Guillaume Paradin, BP 8071, 69376 Lyon Cedex 8, France.

Author Contributions: Conception and design: H. Decousus, I. Quéré, F. Becker, J.L. Gillet, P. Mismetti, O. Pichot.

Analysis and interpretation of the data: H. Decousus, I. Quéré, F. Becker, P. Mismetti, A. Leizorovicz.

Drafting of the article: H. Decousus, P. Mismetti, A. Leizorovicz.

Critical revision of the article for important intellectual content: H. Decousus, I. Quéré, F. Becker, J.L. Gillet, P. Mismetti, O. Pichot, A. Leizorovicz.

Final approval of the article: H. Decousus, I. Quéré, F. Becker, M.T. Barrellier, M. Chanut, H. Guenneguez, C. Leandri, P. Mismetti, O. Pichot, A. Leizorovicz.

Provision of study materials or patients: I. Quéré, M. Chanut, J.L. Gillet, H. Guenneguez, C. Leandri, O. Pichot.

Statistical expertise: E. Presles.

Obtaining of funding: A. Leizorovicz.

Administrative, technical, or logistic support: H. Decousus, I. Quéré, E. Presles, M.T. Barrellier, A. Leizorovicz.

Collection and assembly of data: A. Leizorovicz.


Ann Intern Med. 2010;152(4):218-224. doi:10.7326/0003-4819-152-4-201002160-00006
Text Size: A A A

Background: Superficial venous thrombosis (SVT) is perceived to have a benign prognosis.

Objective: To assess the prevalence of venous thromboembolism in patients with SVT and to determine the 3-month incidence of thromboembolic complications.

Design: National cross-sectional and prospective epidemiologic cohort study. (ClinicalTrials.gov registration number: NCT00818688)

Setting: French office- and hospital-based vascular medicine specialists.

Patients: 844 consecutive patients with symptomatic SVT of the lower limbs that was at least 5 cm on compression ultrasonography.

Measurements: Incidence of venous thromboembolism and extension or recurrence of SVT in patients with isolated SVT at presentation.

Results: Among 844 patients with SVT at inclusion (median age, 65 years; 547 women), 210 (24.9%) also had deep venous thrombosis (DVT) or symptomatic pulmonary embolism. Among 600 patients without DVT or pulmonary embolism at inclusion who were eligible for 3-month follow-up, 58 (10.2%) developed thromboembolic complications at 3 months (pulmonary embolism, 3 [0.5%]; DVT, 15 [2.8%]; extension of SVT, 18 [3.3%]; and recurrence of SVT, 10 [1.9%]), despite 540 patients (90.5%) having received anticoagulants. Risk factors for complications at 3 months were male sex, history of DVT or pulmonary embolism, previous cancer, and absence of varicose veins.

Limitation: The findings are from a specialist referral setting, and the study was terminated before the target patient population was reached because of slow recruitment.

Conclusion: A substantial number of patients with SVT exhibit venous thromboembolism at presentation, and some that do not can develop this complication in the subsequent 3 months.

Primary Funding Source: GlaxoSmithKline, sanofi-aventis, and the Ministère Français de la Santé et des Sports (Programme Hospitalier de Recherche Clinique).

Figures

Grahic Jump Location
Figure.
Study flow diagram.

DVT = deep venous thrombosis; PE = pulmonary embolism; SVT = superficial venous thrombosis.

* Reasons are not mutually exclusive.

Grahic Jump Location

Tables

References

Letters

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Comments

Submit a Comment
Your paper on SVT and VTE
Posted on February 15, 2010
Michael S Lauer
NHLBI, NIH
Conflict of Interest: None Declared

To the authors:

Congratulations on your excellent paper.

Were your 844 patients part of a consecutive series among the practices that agreed to participate in your study? Apologies if I missed it.

Why did you encounter problems with slow enrollment? Was the disease frequency lower than you guessed? Or were you missing patients who were not being enrolled because of local practice issues or refusals.

Conflict of Interest:

None declared

Tobacco consumption and superficial thrombosis
Posted on February 19, 2010
Claude Bachmeyer
CHU Tenon (AP-HP)
Conflict of Interest: None Declared

I read with great interest the article by Decousus et al (1). They describe the risk factors for venous thromboembolism in patients with superficial venous thrombosis, including male sex, history of deep vein thrombosis, previous cancer and absence of varicose veins. However tobacco consumption was not investigated. Indeed thromboangiitis obliterans is a vasculitits that develops in young patients experiencing superficial thrombophlebitis, arterial upper limb involvement and Raynaud's phenomenon in the absence of atherosclerotic risk factors other than smoking (2-3). Its cause is unknown but the relationship with tobacco has been demonstrated, and its frequency is perhaps under-evaluated. The most effective treatment is smoking cessation. Superficial thrombophlebitis is observed in 9.5 to 65% of patients with thromboangiitis obliterans, according to the series and their geographic origin (2-4). In a retrospective Iranian series involving 86 patients, 65.4% of them had a history of superficial thrombophlebitis (4). In 25%, it was the initial presentation, and in 4.7% the main cause of complaint. It occurred 9 years (with extreme at 4 months and 22 years) before the patient present any other sign of thromboangiitis obliterans. Since deep venous thrombophlebitis is unusual in thromboangiitis obliterans, Decousus et al. should have evaluated tobacco consumption in the patients enrolled in their study.

References

1. Decousus H, Quere I, Presles E, Becker F, Barrellier MT, Chanut M, et al. Superficial Venous Thrombosis and Venous Thromboembolism: A Large, Prospective Epidemiologic Study. Ann Intern Med. 2010;152:218-224.

2. Olin JW. Thromboangiitis obliterans (Buerger's disease). N Engl J Med. 2000; 343: 864-9.

3. Shionoya S. Diagnostic criteria of Buerger's disease. Int J Cardiol. 1998;1:243-5.

4. Fazeli B, Modaghegh H, Ravrai H, Kazemzadeh G. Thrombophlebitis migrans as a footprint of Buerger's disease: a prospective-descriptive study in north-east of Iran. Clin Rheumatol. 2008;27:55-7.

Conflict of Interest:

None declared

Hypercoagulable Disorders and Superficial Vein Thrombosis
Posted on February 24, 2010
Matias E Valsecchi
Albert Einstein Medical Center
Conflict of Interest: None Declared

I found the study presented by Decousus et al very interesting (1) in relation to the apparently not so benign course of the symptomatic superficial vein thrombosis (SVT). This study certainly adds more evidence for the screening of deep vein thrombosis (DVT) in these patients and raises valid questions about the potential benefit of systemic anticoagulation. However it is also known that this is a heterogenic population and a group of patients who will definitely benefit from full anticoagulation are those with thrombophilic disorders. In this study, it is striking that despite describing only 5% of known biological thrombophilia, in those patients who had only isolated SVT at diagnosis, over 50% (348/634) had history of SVT, DVT or PE. That proportion rises to 87% (554/634) if we also include positive family history. These figures, together with the fact that some previous studies showed a higher than expected prevalence of thrombophilic states in patients with SVT (2-3), lead to 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 currently unclear if screening for those disorders is cost-effective in patients with SVT. Information retrieved from a prospective clinical trial, like this one, could have significant value.

References

1. Decousus H, Quere I, Presles E, Becker F, Barrellier MT, Chanut M, et al. Superficial Venous Thrombosis and Venous Thromboembolism: A Large, Prospective Epidemiologic Study. Ann Intern Med. 2010;152:218-224.

2. Martinelli I, Cattaneo M, Taioli E, De Stefano V, Chiusolo P, Mannucci PM. Genetic risk factors for superficial vein thrombosis. Thromb Haemost 1999; 82(4):1215-7.

3. de Godoy J, Batigalia F, Braile D. Superficial thrombophlebitis and anticardiolipin antibodies--report of association. Angiology 2001; 52(2):127-9.

Conflict of Interest:

None declared

Following the DVT and PE treatment strategy.
Posted on March 16, 2010
OMAR M. ALBUSTAMI
EAST CAROLINA UNIVERSITY, GREENVILLE, NC, USA
Conflict of Interest: None Declared
In this study, among patients with isolated superficial venous thrombosis (SVT) at inclusion, 2.1% developed asymptomatic thromboembolic complication by day 10 and 8.3% developed at least one symptomatic thromboembolic event at 3 months: symptomatic deep venous thrombosis (DVT) 2.8%; symptomatic pulmonary embolism (PE) 0.5%; symptomatic extension of SVT 3.3%; symptomatic recurrence of SVT 1.9%, despite more than 60% having received anticoagulant drugs at therapeutic doses and nearly all having received elastic stockings. These percentages are expected to be higher if none received LMWHs or vitamin K antagonists as can be inferred from the Stenox trial (1) where 30.6% and 34.5% of the placebo group developed deep and superficial venous thromboembolism by days 12 and 97 respectively. Failure of two previous interventional studies, the Stenox trial (1) failed to show benefit of therapeutic and prophylactic Lovenox in preventing the primary outcome (deep venous thromboembolism: DVT and symptomatic PE) compared to placebo and THE VESALIO INVESTIGATORS GROUP trial (2) failed to show benefit of therapeutic Nadroparin in preventing the primary outcome (SVT progression, DVT and symptomatic PE) compared to prophylactic Nadroparin, was attributed to short duration of intervention (9.6 plus/minus 1.9 days in the Stenox trial and 1 month in the Vesalio trial). The optimal antithrombotic therapeutic strategy to reduce the risk of deep and superficial venous thromboembolism in terms of type of drug, dosage regimen and treatment duration is not known and needs further study. However, following the DVT and PE treatment strategy (with Lovenox/Vitamin K antagonists for 3 months) in SVT of long saphenous vein may be justifiable since the risk-benefit ratio favors this approach given its high safety profile (risk of major bleeding in 3 month period is only 2%, Lovenox induced thrombocytopenia (platelet counts between 100,000/mm3 and 50,000/mm3) occurred at a rate of 1.3%, and platelet counts less than 50,000/mm3 occurred at a rate of 0.1%) [3]. Bleeding complications were considered major: (1) if the hemorrhage caused a significant clinical event, (2) if accompanied by a hemoglobin decrease of more than or equal to 2 g/dL, or (3) transfusion of 2 or more units of blood products. Retroperitoneal, intraocular, and intracranial hemorrhages were considered major (3).

References

1) A Pilot Randomized Double-blind Comparison of a Low-Molecular-Weight Heparin, a Nonsteroidal Anti-inflammatory Agent, and Placebo in the Treatment of Superficial Vein Thrombosis. The Superficial Thrombophlebitis Treated by Enoxaparin Study Group (Stenox), Arch Intern Med. 2003;163:1657-1663.

2) High vs. low doses of low-molecular-weight heparin for the treatment of superficial vein thrombosis of the legs: a double-blind, randomized trial THE VESALIO INVESTIGATORS GROUP, J Thromb Haemost 2005;3:1152-7.

3) Lovenox Prescribing Information.

Conflict of Interest:

None declared

Re:Your paper on SVT and VTE
Posted on April 8, 2010
Herve Decousus
Inserm, CIE3; CHU Saint-Etienne Hospital Nord, Service Medicine et Therapeutique, Saint-Etienne, FR
Conflict of Interest: None Declared

IN RESPONSE: In response to Dr. Lauer's question, we cannot confirm that all centers enrolled consecutive patients into the study. However, this procedure was strongly recommended when the study design was explained to them. Regarding the slowness of recruitment, we believe that this reflected practical considerations of the physicians and/or patients' willingness to participate in the study rather than a lower than expected disease frequency.

We agree with Dr. Bachmeyer that superficial venous thrombosis is common in patients with Buerger's disease (1). However, in western European patients, Buerger's disease is relatively rare (1). In the POST study, very few patients had Buerger's disease: only 2.3% of patients presented an autoimmune disease, this group including not only patients with Buerger's disease, but also patients with other autoimmune diseases, such as Behcet's disease and lupus-like syndromes (2). Consequently, although exposure to tobacco smoke is indeed a key factor in the progression of Buerger's disease, its prognostic value was not analyzed.

The percentage of patients with a personal and a family history of thrombosis is actually lower than that calculated by Dr. Valsecchi by adding together the number of patients with a history of superficial venous thrombosis, the number of patients with a history of deep-vein thrombosis or pulmonary embolism and the number of patients with a family history of thrombosis indicated in the Table 1 of the manuscript (2). Although this Table presents data relating to each of the above three parameters separately, the same patient could be positive for more than one of these parameters, and therefore the number of patients with a personal and family history of thrombosis cannot be obtained by simply combining the three sets of data. In fact, the percentage of patients with a history of superficial venous thrombosis, deep-vein thrombosis or pulmonary embolism was 46.5% (289/621), and the percentage of patients with both a personal and a family history of thrombosis was 61.2% (383/625). At baseline, 5.4% of patients with isolated superficial venous thrombosis had known biological thrombophilia, but biological thrombophilia was not systematically tested in patients with thrombotic complications at three months. However, in univariate analysis, this parameter did not appear to be a risk factor for thromboembolism at three months (hazard ratio: 0.39; 95% confidence interval: [0.05 -2.81]; p=0.35). Therefore, as for deep-vein thrombosis and pulmonary embolism, we believe that the value of screening for biological thrombophilia in patients with superficial venous thrombosis is questionable (3-5).

REFERENCES

1. Olin JW. Thromboangiitis obliterans (Buerger's disease). N Engl J Med. 2000;343: 864-9.

2. Decousus H, Quere I, Presles E, Becker F, Barrellier MT, Chanut M, et al. Superficial Venous Thrombosis and Venous Thromboembolism: A Large, Prospective Epidemiologic Study. Ann Intern Med. 2010;152:218-24.

3. Ridker PM, Goldhaber SZ, Danielson E, Rosenberg Y, Eby CS, Deitcher SR, et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med. 2003;348:1425-34.

4. Kearon C, Julian JA, Kovacs MJ, Anderson DR, Wells P, Mackinnon B, et al; ELATE Investigators. Influence of thrombophilia on risk of recurrent venous thromboembolism while on warfarin: results from a randomized trial. Blood. 2008;112:4432-6.

5. Milio G, Siragusa S, Mina C, Amato C, Corrado E, Grimaudo S, et al. Superficial venous thrombosis: prevalence of common genetic risk factors and their role on spreading to deep veins. Thromb Res. 2008;123:194-9.

Conflict of Interest:

None declared

Re:Tobacco consumption and superficial thrombosis
Posted on April 8, 2010
Herve Decousus
Inserm, CIE3; CHU Saint-Etienne Hospital Nord, Service Medicine et Therapeutique, Saint-Etienne, FR,
Conflict of Interest: None Declared

IN RESPONSE: In response to Dr. Lauer's question, we cannot confirm that all centers enrolled consecutive patients into the study. However, this procedure was strongly recommended when the study design was explained to them. Regarding the slowness of recruitment, we believe that this reflected practical considerations of the physicians and/or patients' willingness to participate in the study rather than a lower than expected disease frequency.

We agree with Dr. Bachmeyer that superficial venous thrombosis is common in patients with Buerger's disease (1). However, in western European patients, Buerger's disease is relatively rare (1). In the POST study, very few patients had Buerger's disease: only 2.3% of patients presented an autoimmune disease, this group including not only patients with Buerger's disease, but also patients with other autoimmune diseases, such as Behcet's disease and lupus-like syndromes (2). Consequently, although exposure to tobacco smoke is indeed a key factor in the progression of Buerger's disease, its prognostic value was not analyzed.

The percentage of patients with a personal and a family history of thrombosis is actually lower than that calculated by Dr. Valsecchi by adding together the number of patients with a history of superficial venous thrombosis, the number of patients with a history of deep-vein thrombosis or pulmonary embolism and the number of patients with a family history of thrombosis indicated in the Table 1 of the manuscript (2). Although this Table presents data relating to each of the above three parameters separately, the same patient could be positive for more than one of these parameters, and therefore the number of patients with a personal and family history of thrombosis cannot be obtained by simply combining the three sets of data. In fact, the percentage of patients with a history of superficial venous thrombosis, deep-vein thrombosis or pulmonary embolism was 46.5% (289/621), and the percentage of patients with both a personal and a family history of thrombosis was 61.2% (383/625). At baseline, 5.4% of patients with isolated superficial venous thrombosis had known biological thrombophilia, but biological thrombophilia was not systematically tested in patients with thrombotic complications at three months. However, in univariate analysis, this parameter did not appear to be a risk factor for thromboembolism at three months (hazard ratio: 0.39; 95% confidence interval: [0.05-2.81]; p=0.35). Therefore, as for deep-vein thrombosis and pulmonary embolism, we believe that the value of screening for biological thrombophilia in patients with superficial venous thrombosis is questionable (3-5).

REFERENCES

1. Olin JW. Thromboangiitis obliterans (Buerger's disease). N Engl J Med. 2000;343: 864-9.

2. Decousus H, Quere I, Presles E, Becker F, Barrellier MT, Chanut M, et al. Superficial Venous Thrombosis and Venous Thromboembolism: A Large, Prospective Epidemiologic Study. Ann Intern Med. 2010;152:218-24.

3. Ridker PM, Goldhaber SZ, Danielson E, Rosenberg Y, Eby CS, Deitcher SR, et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med. 2003;348:1425-34.

4. Kearon C, Julian JA, Kovacs MJ, Anderson DR, Wells P, Mackinnon B, et al; ELATE Investigators. Influence of thrombophilia on risk of recurrent venous thromboembolism while on warfarin: results from a randomized trial. Blood. 2008;112:4432-6.

5. Milio G, Siragusa S, Mina C, Amato C, Corrado E, Grimaudo S, et al. Superficial venous thrombosis: prevalence of common genetic risk factors and their role on spreading to deep veins. Thromb Res. 2008;123:194-9.

Conflict of Interest:

None declared

Re:Tobacco consumption and superficial thrombosis
Posted on April 8, 2010
Herve Decousus
Inserm, CIE3; CHU Saint-Etienne Hospital Nord, Service Medicine et Therapeutique, Saint-Etienne, FR,
Conflict of Interest: None Declared

IN RESPONSE: In response to Dr. Lauer's question, we cannot confirm that all centers enrolled consecutive patients into the study. However, this procedure was strongly recommended when the study design was explained to them. Regarding the slowness of recruitment, we believe that this reflected practical considerations of the physicians and/or patients' willingness to participate in the study rather than a lower than expected disease frequency.

We agree with Dr. Bachmeyer that superficial venous thrombosis is common in patients with Buerger's disease (1). However, in western European patients, Buerger's disease is relatively rare (1). In the POST study, very few patients had Buerger's disease: only 2.3% of patients presented an autoimmune disease, this group including not only patients with Buerger's disease, but also patients with other autoimmune diseases, such as Behcet's disease and lupus-like syndromes (2). Consequently, although exposure to tobacco smoke is indeed a key factor in the progression of Buerger's disease, its prognostic value was not analyzed.

The percentage of patients with a personal and a family history of thrombosis is actually lower than that calculated by Dr. Valsecchi by adding together the number of patients with a history of superficial venous thrombosis, the number of patients with a history of deep-vein thrombosis or pulmonary embolism and the number of patients with a family history of thrombosis indicated in the Table 1 of the manuscript (2). Although this Table presents data relating to each of the above three parameters separately, the same patient could be positive for more than one of these parameters, and therefore the number of patients with a personal and family history of thrombosis cannot be obtained by simply combining the three sets of data. In fact, the percentage of patients with a history of superficial venous thrombosis, deep-vein thrombosis or pulmonary embolism was 46.5% (289/621), and the percentage of patients with both a personal and a family history of thrombosis was 61.2% (383/625). At baseline, 5.4% of patients with isolated superficial venous thrombosis had known biological thrombophilia, but biological thrombophilia was not systematically tested in patients with thrombotic complications at three months. However, in univariate analysis, this parameter did not appear to be a risk factor for thromboembolism at three months (hazard ratio: 0.39; 95% confidence interval: [0.05-2.81]; p=0.35). Therefore, as for deep-vein thrombosis and pulmonary embolism, we believe that the value of screening for biological thrombophilia in patients with superficial venous thrombosis is questionable (3-5).

REFERENCES

1. Olin JW. Thromboangiitis obliterans (Buerger's disease). N Engl J Med. 2000;343: 864-9.

2. Decousus H, Quere I, Presles E, Becker F, Barrellier MT, Chanut M, et al. Superficial Venous Thrombosis and Venous Thromboembolism: A Large, Prospective Epidemiologic Study. Ann Intern Med. 2010;152:218-24.

3. Ridker PM, Goldhaber SZ, Danielson E, Rosenberg Y, Eby CS, Deitcher SR, et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med. 2003;348:1425-34.

4. Kearon C, Julian JA, Kovacs MJ, Anderson DR, Wells P, Mackinnon B, et al; ELATE Investigators. Influence of thrombophilia on risk of recurrent venous thromboembolism while on warfarin: results from a randomized trial. Blood. 2008;112:4432-6.

5. Milio G, Siragusa S, Mina C, Amato C, Corrado E, Grimaudo S, et al. Superficial venous thrombosis: prevalence of common genetic risk factors and their role on spreading to deep veins. Thromb Res. 2008;123:194-9.

Conflict of Interest:

None declared

Submit a Comment

Summary for Patients

Observations of the Relationship Between Surface and Deep Leg Blood Vein Clotting

The summary below is from the full report titled “Superficial Venous Thrombosis and Venous Thromboembolism. A Large, Prospective Epidemiologic Study.” It is in the 16 February 2010 issue of Annals of Internal Medicine (volume 152, pages 218-224). The authors are H. Decousus, I. Quéré, E. Presles, F. Becker, M.T. Barrellier, M. Chanut, J.L. Gillet, H. Guenneguez, C. Leandri, P. Mismetti, O. Pichot, and A. Leizorovicz, for the POST (Prospective Observational Superficial Thrombophlebitis) Study Group.

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