Elsevier

Thrombosis Research

Volume 136, Issue 5, November 2015, Pages 938-942
Thrombosis Research

Full Length Article
A clinical score to rule out the concomitant presence of deep vein thrombosis in patients presenting with superficial vein thrombosis: The ICARO study

https://doi.org/10.1016/j.thromres.2015.09.010Get rights and content

Highlights

  • A major DVT appears to be common in patients with SVT.

  • Age > 50 years, cancer, and edema were associated with an increased risk of DVT.

  • DVT appeared less common in idiopathic SVT and in patients with rope-like sign.

Abstract

Background

Superficial vein thrombosis (SVT) is commonly encountered in clinical practice. Recent studies have suggested that the concomitant presence of deep vein thrombosis (DVT) or pulmonary embolism (PE) at the time of SVT diagnosis is not uncommon, thus increasing the interest on this disease. Whether this coexistence is predicted by specific risk factors remains unknown.

Aim of the study

To evaluate potential risk factors for DVT coexistence in patients presenting with acute objectively diagnosed SVT of the lower limbs and to develop a simple score entirely based on clinical variables to define the pre-test probability of DVT in these patients.

Methods

A multicenter, retrospective cohort study on SVT patients was conducted. Information was collected on clinical signs and on risk factors for venous thrombosis.

Results

494 patients (mean age 56.3 ± 17.9 years, 64.2% women) were included. Concomitant DVT was found in 16.0% of patients. After multivariate analysis, we identified 5 independent variables that were used to develop the ICARO score: active malignancy (1.5 points), limb edema (1.5 points), rope-like sign (− 1 point), age  50 years (1 point), unprovoked SVT (− 1 point). The prevalence of concomitant DVT was 1.1% in the low-probability category (< 0 points), 12.0% in the intermediate-probability category (0 to 1 points), and 32.3% in the high probability category (≥ 1.5 points).

Conclusions

The concomitant presence of major DVT is not negligible in patients with SVT. Our prediction score entirely based on simple clinical variables may be useful in assessing the risk of concomitant DVT in these patients.

Introduction

Superficial vein thrombosis (SVT) is a common disease that most often affects the veins of the lower limbs, but that can also be found in other locations. The great saphenous vein is involved in 60% to 80% of cases, and the small saphenous vein in 10% to 20% [1]. SVT is mainly characterized by the presence of a warm, red, tender, swollen area along the course of a superficial vein, often palpable as a cord usually affecting the lower part of the legs.

Little information is available on the epidemiology of SVT of the lower limbs. It has been estimated to have a prevalence of 3–11% in the general population [2], and in a recent community-based study the annual incidence of symptomatic SVT appeared of 0.64‰ inhabitants/year [3]. Furthermore, its prevalence appears to be approximately two-fold higher than that of deep-vein thrombosis (DVT) and pulmonary embolism (PE) combined in a study conducted among patients attending general practitioners [4].

Predisposing risk factors for SVT are similar to those for DVT or PE and include personal or family history of venous thromboembolism, active malignancy, recent surgery or trauma, immobilization, inherited thrombophilia, use of oral contraceptives, infectious diseases, obesity and cardiac or respiratory failure [5], [6].

SVT has long been considered a benign entity with more local than systemic implications. It has become recently more clear, however, that SVT may be a manifestation of a systemic tendency to thrombosis, with a non-negligible risk of recurrence or concomitant DVT or PE at the time of SVT diagnosis [7]. Unfortunately, available data on this association are not conclusive, ranging between 6% and 36% for concomitant DVT and up to 33% for PE [1], [8]. Furthermore, factors associated with the concomitant presence of major thromboembolic events have not been explored.

To better assess this issue, we conducted a large, multicenter, retrospective cohort study with the aim of identifying clinical variables potentially associated with an increased risk of concomitant DVT in a population of patients with SVT of the lower limbs.

Section snippets

Materials and methods

The study was carried on in five Italian centers: Cuneo, Napoli, Palermo, Udine and Varese.

All centers were hospital-based Thrombosis Units or Anticoagulation Clinics that are routinely involved in the management of SVT patients, including diagnosis, evaluation of specific risk factors, management of anticoagulant treatment, and long-term follow-up.

Results

Four hundred and ninety-four patients with SVT were included in the study. Baseline demographic characteristics and potential risk factors for SVT are summarized in Table 1.

The mean patient age was 56.3 ± 17.9 years, 314 patients (63.7%) were female and 91 patients (19.0%) were obese; 85 patients (17.2%) had a personal history of DVT or PE and 175 patients (36.0%) had a previous episode of SVT. A family history of DVT or PE was recorded in almost one third of patients (31.0%); 216 patients (43.7%)

Discussion

Superficial vein thrombosis of the lower extremities is a common disease, with an estimated incidence of 0.5–1 per 1000 inhabitants per year [11], [12], [3]. Although it has been traditionally considered a relatively benign disease, a number of recent studies have suggested a not uncommon concomitant presence of DVT and/or PE in these patients [5], [13], [14], [15] and a non-negligible risk of recurrence at follow up [16], [7], questioning the benign nature of this disease. It is important to

Conflict-of-interest disclosure

The authors declare no competing financial interests.

Authors' contributions

F. Dentali and F. Pomero were involved in conception and design of the study, analysis and interpretation of data, drafting and critical revision of the manuscript and statistical analysis.

M.N.D. Di Minno, W. Ageno, S. Siragusa and G. Di Minno were involved in conception and design of the study, analysis and interpretation of data, critical revision and drafting of the manuscript.

E. Tamburini Premunian, A. Malato, S. Pasca, G. Barillari and L. Fenoglio were involved in the acquisition of data,

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