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Deep vein thrombosis

Prevalence
Clinical features
Differential diagnosis
Investigations
Therapy
Prevention
Prognosis
Prognosis

The risk of recurrent venous thromboembolism is increased with a
  • cancer a
  • impaired coagulation inhibition a
  • a proximal DVT a
  • a history of venous thromboembolism a

and reduced with 

  • recent surgery a
  • recent trauma or fracture a
  • longer duration of anticoagulation
Why?

Cancer and clotting disorders increase the risk of venous thromboembolism

Patient Prognostic Factor Outcome CER OR
(95% CI)
NNF+
(95% CI)
first DVT  a   cancer
independent
recurrent venous thromboembolism
at 2 years
18% 1.72
(1.31 to 2.25)
8
(5 to 19)
  impaired coagulation inhibition
independent
    1.44
(1.02 to 2.01)
14
(7 to 270)
DVT a proximal DVT
independent
recurrent venous thromboembolism
at 5 years
20% 2.30
(1.55 to 3.42)
6
(4 to 13)
  history of venous thromboembolism
independent
    1.71
(1.16 to 2.52)
10
(5 to 41)
first DVT  a   recent surgery
independent
recurrent venous thromboembolism
at 2 years
18% 0.36
(0.21 to 0.62)
-7
(-13 to -5)
  recent trauma or fracture
independent
    0.51
(0.32 to 0.87)
-10
(-40 to -7)
DVT a longer duration of anticoagulation 
independent
recurrent venous thromboembolism
at 5 years
20% 0.95
(0.92 to 0.98)
-130
(-310 to -80)

 

Expiry date: January 2004
Levels of Evidence used in grading these guides

Author   C   Ball
Reviewer   J   Ginsberg
CAT Writers   C   Ball , B   Phillips