Abstract

SY37 Relapsing, recurrent and residual deep vein thrombosis Hall 3 09:30 16th July, 2003 Session Type: Symposium Subject area: Invited Speaker Session title: Predicting the risk of recurrence of venous thromboembolism Abstract: SY37 Authors: A. Girolami University of Padua, Italy The term relapsing indicates an event that presents a worsening after an apparently early improvement during a given therapy. Strictly correlated with the concept of relapsing thrombosis is the event of an extension. This may occur in the original site or involve a controlateral limb or any other venous district. The term recurrent should refer to an event that reoccurs after the healing or disappearance of a previous one. The adjective residual should be limited to the presence of thrombus mass in a given vein after the completion of the chosen therapy or during secondary prophylaxis. In clinical practice a clear distinction among those entities is not always feasible. Problems may be summarized as follows: (a) relapsing may occur because of inadequate or apparently adequate therapy. Relapsing and or extension of VTE occurs, in other words, during the acute phase of the illness while the patient is still undergoing anticoagulanted therapy. Other causes may be occult (or overt) cancer, congenital defects, persistence of other risk factors (ex. immobilization, etc.). (b) Recurrent thrombosis is the one that occurs after the apparent healing or sharp improvement of the previous event. This occurs after the discontinuation of the anticoagulant. Factors which seem to increase the rate of recurrence are: overt or occult cancer, congenital thrombophilia reappearance of other risk factors. An increased rate of recurrence seems demonstrated for major thrombophilic conditions or for a combination of two polymorphisms. (c) Residual thrombosis is represented by the thrombosis which can remain after adequate treatment and stabilization has been reached. The evaluation and significance of residual vein thrombosis is not clear. First of all, it is very difficult to quantitate it. CUS may give some indications but it is not an objective method. Venography could give further information but its use is limited. Does it indicate a tendency towards recurrence? Should it undergo treatment? Does the amount or size of residual vein thrombosis depend on therapy used at onset?. Influencing factors could be: congenital deficiency of clotting inhibitors, vein malformation. It is conceivable that residual vein thrombosis may be responsible for the persistently high levels of D-Dimers seen occasionally in some patients post DVT. Since these high levels have been considered as a cause for recurrence, it could be surmised that the same is true for residual vein thrombosis. file:///E|/working/LAXMI-PRASAD/WileyML-3G/deepak/31-Jan/Wednesday/Abstract%20SY37.html (1 of 2) [1/31/2014 3:52:05 PM]