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Blood, 1 August 2008, Vol. 112, No. 3, pp. 511-515.
Prepublished online as a Blood First Edition Paper on May 27, 2008May 22, 2008; DOI 10.1182/blood-2008-01-131656.
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Submitted January 2, 2008
Accepted April 21, 2008
Residual vein thrombosis to establish duration of anticoagulation after a first episode of deep vein thrombosis: the "DACUS" study
Sergio Siragusa Prof.*, Alessandra Malato, Raffaela Anastasio, Valeria Cigna, Glauco Milio, Corrado Amato, Mario Bellisi, Maria Teresa Attanzio, Oreste Cormaci, Massimo Pellegrino, Alberto Dolce, Alessandra Casuccio, Guido Bajardi, and Guglielmo Mariani
Cattedra ed U.O. di Ematologia con trapianto, Universita degli Studi di Palermo, Palermo, Italy
Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Universita degli Studi di Palermo, Palermo, Italy
Dipartimento di Discipline Chirurgiche ed Anatomiche, Universita degli Studi di Palermo, Palermo, Italy
Unita di Chirurgia Vascolare, Ospedale Garibaldi di Catania, Catania, Italy
Unita di Patologia Vascolare, Ospedale Civile S. Antonio di Trapani, Trapani, Italy
Dipartimento di Neuroscienze Cliniche, Universita degli Studi di Palermo, Palermo, Italy
Dipartimento di Medicina Interna e Sanità Pubblica, Universita degli Studi de L'Aquila, L'Aquila, Italy
* Corresponding author; email: sergio.siragusa{at}unipa.it.
Residual Vein Thrombosis (RVT) indicates a pro-thrombotic state and be useful for evaluating the optimal duration of Oral Anticoagulant Treatment (OAT). Patients with a first episode of deep vein thrombosis, treated with OAT for 3 months, were managed accordingly to RVT findings. Those with RVT were randomized to either stop or continue anticoagulants for 9 additional months, while in those without RVT , OAT was stopped. Outcomes were recurrent venous thromboembolism and/or major bleeding. Residual thrombosis was detected in 181/258 patients (70.2%); recurrent events occurred in 27.2% of those who discontinued (25/92; 15.2% person-yr) and in 19.3% of those who continued OAT (17/88; 10.1% person-yr). The relative adjusted hazard ratio (HR) was 1.58 (95% CI, 0.85-2.93; p = 0.145). Of the 78 (30.2%) patients without RVT, only one (1.3%; 0.63% person-yr) had a recurrence. The adjusted HR of patients with RVT versus those without was 24.9 (95% CI, 3.4-183.6; p = 0.002). One major bleeding event (1.1%; 0.53% person-yr) occurred in patients who stopped and two (2.3%; 1.1% person-yr) in those who continued OAT. Absence of RVT, after 3 months of OAT, may identify a group of patients at very low risk for recurrent thrombosis who can safely stop OAT.
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