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Recurrent Deep Vein Thrombosis: Long-Term Incidence and Natural History

Labropoulos, Nicos PhD, DIC, RVT; Jen, James MD; Jen, Henry; Gasparis, Antonios P. MD; Tassiopoulos, Apostolos K. MD

doi: 10.1097/SLA.0b013e3181d568db
Original Articles

Objective: To determine the long-term incidence, risk factors, and associated morbidity and mortality of recurrent deep vein thrombosis (DVT).

Summary Background Data: Few studies have examined the long-term natural history and impact of recurrent DVT.

Methods: We conducted a prospective observational study that followed 153 consecutive patients with an acute first episode of DVT. Clinical examination and ultrasound were performed serially for at least 5 years. Location and extent of the initial DVT, recurrence, pulmonary embolism, cause of mortality, signs and symptoms of post thrombotic syndrome (PTS), and the risk factors were recorded.

Results: The incidence of recurrence at 5 years was 26.1%. Patients with both proximal and distal DVT had a higher recurrence rate than proximal (17/48 35% vs. 12/49, 24%, P = 0.27) or calf alone (11/56, 20%, P = 0.08). Unprovoked DVT and age >65 years were associated with higher recurrence rates (P < 0.001; relative risk [RR]: 2.9, 95% confidence interval [CI]: 1.5–5.7) and (P = 0.025; RR: 1.5, 95% CI: 1–2.3), respectively. Thrombophilia was not associated with increased risk of recurrence (P = 0.21). Patients with DVT due to surgery or trauma had a lower recurrence (P < 0.001). Ipsilateral recurrence was associated with increased severity of PTS (P < 0.001; RR: 1.6, 95% CI: 1.4–2.2). PE occurred 47 times, 12 (25%) of which were fatal events.

Conclusions: Factors associated with a higher rate of recurrence included unprovoked DVT and age >65. Elevated thrombus burden had a trend towards higher risk. Patients with surgery and trauma had low recurrence rates. Ipsilateral recurrence was strongly associated with PTS. PE occurred frequently and was a common cause of death.

The authors followed 153 patients with a first episode of acute deep vein thrombosis for 5 years. Risk factors for recurrence and post-thrombotic syndrome were identified. A 26.1% incidence of recurrence was found at 5 years with an associated 30.7% incidence of pulmonary embolism.

From the Division of Vascular Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY.

Support by Departments of Surgery, Loyola University Medical Center and Stony Brook University Medical Center.

Presented in the 21st Annual Meeting of the American Venous Forum, February 11–14, 2009, Phoenix Arizona.

Reprints: Nicos Labropoulos, PhD, Department of Surgery and Radiology, SUNY at Stony Brook, HSC T-19, Room 090, Stony Brook, NY 11794. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.