Risk for Venous Thromboembolism in Patients With Superficial Venous Thrombosis
Authors: Hervé Decousus
Journal: Annals of Internal Medicine (2010)

Letters6 July 2010Risk for Venous Thromboembolism in Patients With Superficial Venous ThrombosisHervé Decousus, MD, Isabelle Quéré, MD, and Alain Leizorovicz, MDHervé Decousus, MDFrom INSERM CIE3, Université de Saint-Etienne, 42055 Saint-Etienne, France; Saint Eloi University Hospital, 34295 Montpellier, France; and Faculté Laënnec, 69376 Lyon, France.Search for more papers by this author, Isabelle Quéré, MDFrom INSERM CIE3, Université de Saint-Etienne, 42055 Saint-Etienne, France; Saint Eloi University Hospital, 34295 Montpellier, France; and Faculté Laënnec, 69376 Lyon, France.Search for more papers by this author, and Alain Leizorovicz, MDFrom INSERM CIE3, Université de Saint-Etienne, 42055 Saint-Etienne, France; Saint Eloi University Hospital, 34295 Montpellier, France; and Faculté Laënnec, 69376 Lyon, France.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-1-201007060-00026 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:In response to Dr. Lauer's questions, we cannot confirm that all centers enrolled consecutive patients into the study. However, this approach was strongly recommended when the study design was explained to them. We believe that the slowness of recruitment reflected practical considerations of the physicians and patients' willingness to participate in the study rather than a lower-than-expected disease frequency.We agree with Dr. Bachmeyer that SVT is common in patients with Buerger disease (1). However, in western European patients, Buerger disease is relatively rare (1). In the POST (Prospective Observational Superficial Thrombophlebitis) study, very few patients had Buerger disease: Only 2.3% of patients presented with an autoimmune disease, including not only Buerger disease but also other autoimmune diseases, such as Behçet disease and lupus-like syndromes. Therefore, although exposure to tobacco smoke is indeed a key factor in the progression of Buerger disease, its prognostic value was not analyzed.As indicated in Table 1 of our article, the percentage of patients with a personal and family history of thrombosis is actually lower than that calculated by Dr. Valsecchi by adding together the number of patients with a history of SVT, the number of patients with a history of DVT or pulmonary embolism, and the number of patients with a family history of thrombosis. Although this table presents data relating to each of these 3 variables separately, the same patient could be positive for more than 1; therefore, the number of patients with a personal and a family history of thrombosis cannot be obtained by simply combining the 3 sets of data. In fact, the percentage of patients with a history of SVT, DVT, or pulmonary embolism was 46.5% (289 of 621), and the percentage of patients with both a personal and a family history of thrombosis was 61.2% (383 of 625). At baseline, 5.4% of patients with isolated SVT had known biological thrombophilia, but biological thrombophilia was not systematically tested in patients with thrombotic complications at 3 months. However, in univariate analysis, this variable did not seem to be a risk factor for thromboembolism at 3 months (hazard ratio, 0.39 [95% CI, 0.05 to 2.81]; P = 0.35). Therefore, as for DVT and pulmonary embolism, we believe that the value of screening for biological thrombophilia in patients with SVT is questionable (2–4).Hervé Decousus, MDINSERM CIE3, Université de Saint-Etienne42055 Saint-Etienne, FranceIsabelle Quéré, MDSaint Eloi University Hospital34295 Montpellier, FranceAlain Leizorovicz, MDFaculté Laënnec69376 Lyon, FranceReferences1. Olin JW. Thromboangiitis obliterans (Buerger's disease). N Engl J Med. 2000;343:864-9. [PMID: 10995867] CrossrefMedlineGoogle Scholar2. Ridker PM, Goldhaber SZ, Danielson E, Rosenberg Y, Eby CS, Deitcher SR, et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med. 2003;348:1425-34. [PMID: 12601075] CrossrefMedlineGoogle Scholar3. Kearon C, Julian JA, Kovacs MJ, Anderson DR, Wells P, Mackinnon B, et al; ELATE Investigators. Influence of thrombophilia on risk of recurrent venous thromboembolism while on warfarin: results from a randomized trial. Blood. 2008;112:4432-6. [PMID: 18791166] CrossrefMedlineGoogle Scholar4. Milio G, Siragusa S, Minà C, Amato C, Corrado E, Grimaudo S, et al. Superficial venous thrombosis: prevalence of common genetic risk factors and their role on spreading to deep veins. Thromb Res. 2008;123:194-9. [PMID: 18387654] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From INSERM CIE3, Université de Saint-Etienne, 42055 Saint-Etienne, France; Saint Eloi University Hospital, 34295 Montpellier, France; and Faculté Laënnec, 69376 Lyon, France.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSuperficial Venous Thrombosis and Venous Thromboembolism Hervé Decousus , Isabelle Quéré , Emilie Presles , François Becker , Marie-Thérèse Barrellier , Myriam Chanut , Jean-Luc Gillet , Hervé Guenneguez , Christine Leandri , Patrick Mismetti , Olivier Pichot , Alain Leizorovicz , and Risk for Venous Thromboembolism in Patients With Superficial Venous Thrombosis Michael S. Lauer Risk for Venous Thromboembolism in Patients With Superficial Venous Thrombosis Claude Bachmeyer Risk for Venous Thromboembolism in Patients With Superficial Venous Thrombosis Matias E. Valsecchi Metrics 6 July 2010Volume 153, Issue 1Page: 63KeywordsAutoimmune diseasesConflicts of interestFactor analysisMedical risk factorsObservational studiesPulmonary embolismThromboembolismThrombosisVenous thromboembolism ePublished: 6 July 2010 Issue Published: 6 July 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...