Stefano Barco1, Frederikus A Klok2, Isabelle Mahé3, Pablo Javier Marchena4, Aitor Ballaz5, Carmen Mª Rubio6, Mª Dolores Adarraga7, Daniela Mastroiacovo8, Stavros V Konstantinides9, Manuel Monreal10. 1. Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany. Electronic address: s.barco@uni-mainz.de. 2. Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 3. Department of Internal Medicine, Hôpital Louis Mourier, Colombes (APHP), University Paris 7, France. 4. Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain. 5. Department of Pneumonology, Hospital de Galdakao, Vizcaya, Spain. 6. Department of Internal Medicine, Hospital Alto Guadalquivir Andújar, Jaén, Spain. 7. Department of Internal Medicine, Hospital de Montilla, Córdoba, Spain. 8. Department of Angiology, Ospedale SS. Filippo e Nicola, Avezzano, Italy. 9. Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany. 10. Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain. Universidad Católica de Murcia, Spain.
Abstract
BACKGROUND AND AIMS: Sex-specific differences exist for the initial presentation of acute venous thromboembolism (VTE): men are more likely to present with proximal deep vein thrombosis (DVT) in the lower limbs (versus pulmonary embolism [PE] or isolated distal DVT [IDDVT]) than women. We studied in detail the influence of sex, age, and VTE risk factors on the initial presentation of IDDVT versus proximal DVT. METHODS: A total of 24,911 patients with a first episode of objectively diagnosed acute symptomatic lower-limb DVT (without symptomatic PE) were enrolled in RIETE (years 2000-2017) and included in the present analysis. RESULTS: A total of 4266 (17.1%) patients had IDDVT. No trend for more IDDVT diagnoses was observed over time. Women aged 40-69 had a higher proportion of IDDVT, especially between 40 and 49 years (+6.7%; 95CI +3.7%; +9.9%), whereas men had more often proximal DVT. The presenting location of first acute DVT depended on sex, age, and the prevalence and type of VTE risk factors. Recent surgery was independently associated with a diagnosis of IDDVT in both women and men, whereas active cancer and pregnancy were associated with proximal DVT. CONCLUSIONS: The interaction between age and VTE risk factors influences the presenting location (distal versus proximal) of the first acute lower-limb DVT observed in women and men. Our observations extend to IDDVT the concept that different clinical manifestations of acute VTE may not fully share the same pathophysiological mechanisms: this contributes to explain sex-specific prognostic differences.
BACKGROUND AND AIMS: Sex-specific differences exist for the initial presentation of acute venous thromboembolism (VTE): men are more likely to present with proximal deep vein thrombosis (DVT) in the lower limbs (versus pulmonary embolism [PE] or isolated distal DVT [IDDVT]) than women. We studied in detail the influence of sex, age, and VTE risk factors on the initial presentation of IDDVT versus proximal DVT. METHODS: A total of 24,911 patients with a first episode of objectively diagnosed acute symptomatic lower-limb DVT (without symptomatic PE) were enrolled in RIETE (years 2000-2017) and included in the present analysis. RESULTS: A total of 4266 (17.1%) patients had IDDVT. No trend for more IDDVT diagnoses was observed over time. Women aged 40-69 had a higher proportion of IDDVT, especially between 40 and 49 years (+6.7%; 95CI +3.7%; +9.9%), whereas men had more often proximal DVT. The presenting location of first acute DVT depended on sex, age, and the prevalence and type of VTE risk factors. Recent surgery was independently associated with a diagnosis of IDDVT in both women and men, whereas active cancer and pregnancy were associated with proximal DVT. CONCLUSIONS: The interaction between age and VTE risk factors influences the presenting location (distal versus proximal) of the first acute lower-limb DVT observed in women and men. Our observations extend to IDDVT the concept that different clinical manifestations of acute VTE may not fully share the same pathophysiological mechanisms: this contributes to explain sex-specific prognostic differences.
Authors: Sebastian Schellong; Walter Ageno; Ivan B Casella; Kok Han Chee; Sam Schulman; Daniel E Singer; Marc Desch; Wenbo Tang; Isabelle Voccia; Kristina Zint; Samuel Z Goldhaber Journal: Semin Thromb Hemost Date: 2021-05-10 Impact factor: 6.398
Authors: David Spirk; Tim Sebastian; Jürg Hans Beer; Lucia Mazzolai; Drahomir Aujesky; Daniel Hayoz; Rolf Peter Engelberger; Wolfgang Korte; Nils Kucher; Stefano Barco Journal: Intern Emerg Med Date: 2021-11-03 Impact factor: 5.472