Embolic Risk of Deep Vein Thrombosis is not Related to the Nature of Proximal Clot

Rylnikov D.V.; Seliverstov E.I.; An E.S.; Kuperin A.S.; Lebedev I.S.; Zolotukhin I.A.

doi:https://doi.org/10.17116/flebo202418021115

Rylnikov D.V.

Pirogov Russian National Research Medical University

ORCID: 0009-0004-8196-9725

Seliverstov E.I.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No. 1

SPIN RSCI: 9011-1989
Scopus AuthorID: 24332884500
ORCID: 0000-0002-9726-4250

An E.S.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No.1

ORCID: 0009-0000-2539-1974

Kuperin A.S.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No. 1

ORCID: 0009-0000-5661-3533

Lebedev I.S.

Pirogov Russian National Research Medical University

ORCID: 0000-0001-7956-3807

Zolotukhin I.A.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No. 1

SPIN RSCI: 3426-2981
Scopus AuthorID: 8312153900
ResearcherID: P-5001-2016
ORCID: 0000-0002-6563-0471

Embolic Risk of Deep Vein Thrombosis is not Related to the Nature of Proximal Clot

Authors:

Rylnikov D.V., Seliverstov E.I., An E.S., Kuperin A.S., Lebedev I.S., Zolotukhin I.A.

More about the authors

Journal: Journal of Venous Disorders. 2024;18(2): 115‑121

DOI: 10.17116/flebo202418021115

Read: 1417 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Rylnikov DV, Seliverstov EI, An ES, Kuperin AS, Lebedev IS, Zolotukhin IA. Embolic Risk of Deep Vein Thrombosis is not Related to the Nature of Proximal Clot. Journal of Venous Disorders. 2024;18(2):115‑121. (In Russ.)
https://doi.org/10.17116/flebo202418021115

Подписка 2026 Флебология (Journal of Venous Disorders)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To evaluate the incidence of symptomatic PE in patients with proximal embolic (floating) thrombus under standard anticoagulation.

MATERIAL AND METHODS

We analyzed patients with proximal venous thrombosis above the femoral vein. The main group (embolic thrombosis) included 60 patients with floating clot length of 9.3±2.3 cm, the control group (non-embolic thrombosis) — 164 patients with floating clot length of 2.2±2.2 cm (p<0.0001). The main endpoint was the incidence of symptomatic PE after onset of anticoagulation. In-hospital mortality and hospital-stay were also assessed.

RESULTS

Patients with embolic thrombosis were younger (59.6±14.7 and 64.9±16.4 years, respectively, p=0.029). Proximal level of thrombosis below the inguinal ligament was found in 49 (81.6%) and 102 (62%) patients, respectively (p=0.006). Mean hospital-stay was 9.2±3.3 and 6.0±1.9 days, respectively (p<0.0001). In-hospital PE occurred in 2 (1.2%) patients of the control group. No PE was observed in the main group (p=0.952). There were no deaths in both groups.

CONCLUSION

Incidence of symptomatic PE is similar in patients with embolic and non-embolic deep vein thrombosis receiving adequate anticoagulation in accordance with clinical guidelines.

Keywords:

deep vein thrombosis

pulmonary embolism

floating thrombus

vena cava filter

Authors:

Rylnikov D.V.

Pirogov Russian National Research Medical University

ORCID: 0009-0004-8196-9725

Seliverstov E.I.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No. 1

SPIN RSCI: 9011-1989
Scopus AuthorID: 24332884500
ORCID: 0000-0002-9726-4250

An E.S.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No.1

ORCID: 0009-0000-2539-1974

Kuperin A.S.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No. 1

ORCID: 0009-0000-5661-3533

Lebedev I.S.

Pirogov Russian National Research Medical University

ORCID: 0000-0001-7956-3807

Zolotukhin I.A.

Pirogov Russian National Research Medical University;
Pirogov Moscow City Clinical Hospital No. 1

SPIN RSCI: 3426-2981
Scopus AuthorID: 8312153900
ResearcherID: P-5001-2016
ORCID: 0000-0002-6563-0471

Received:

29.03.2024

Accepted:

05.04.2024

Close metadata

References:

Kesselman A, Oo TH, Johnson M, Stecker MS, Kaufman J, Trost D. Current Controversies in Inferior Vena Cava Filter Placement: AJR Expert Panel Narrative Review. American Journal of Roentgenology. 2021;216(3):563-569. https://doi.org/10.2214/AJR.20.24817
Crumley KD, Hyatt E, Kalva SP, Shah H. Factors Affecting Inferior Vena Cava Filter Retrieval: A Review. Vasc Endovascular Surg. 2019;53(3):224-229. https://doi.org/10.1177/1538574418814061
Mohapatra A, Liang NL, Chaer RA, Tzeng E. Persistently low inferior vena cava filter retrieval rates in a population-based cohort. J Vasc Surg Venous Lymphat Disord. 2019;7(1):38-44. https://doi.org/10.1016/j.jvsv.2018.08.006
Arslanbekov MM, Efremova OI, Lebedev IS, Kirienko AI, Zolotukhin IA. Inferior vena cava filters utilization in patients with venous thromboembolism: Analysis of a database of a tertiary hospital. Phlebology. 2021;36(6): 450-455. https://doi.org/10.1177/0268355520975582
Eight-Year Follow-Up of Patients With Permanent Vena Cava Filters in the Prevention of Pulmonary Embolism. Circulation. 2005;112(3):416-422. https://doi.org/10.1161/CIRCULATIONAHA.104.512834
Mismetti P, Laporte S, Pellerin O, Ennezat P, Couturaud F, Elias A, Fal vo N, Meneveau N, Quere I, Roy P, Sanchez O, Schmidt J, Seinturier C, Sevestre M, Beregi J, Tardy B, Lacroix P, Presles E, Leizorovicz A, Decou sus H, Barral F, Meyer G. Effect of a Retrievable Inferior Vena Cava Filter Plus Anticoagulation vs Anticoagulation Alone on Risk of Recurrent Pulmonary Embolism. JAMA. 2015;313(16):1627. https://doi.org/10.1001/jama.2015.3780
Bikdeli B, Chatterjee S, Desai NR, Kirtane A, Desai M, Bracken M, Spencer F, Monreal M, Goldhaber S, Krumholz H. Inferior Vena Cava Filters to Prevent Pulmonary Embolism. J Am Coll Cardiol. 2017;70(13):1587-1597. https://doi.org/10.1016/j.jacc.2017.07.775
Stevens SM, Woller SC, Kreuziger LB, Bounameaux H, Doerschug K, Geersing G, Huisman M, Kearon C, King C, Knighton A, Lake E, Murin S, Vin tch J, Wells P, Moores L. Antithrombotic Therapy for VTE Disease. Chest. 2021;160(6):e545-e608. https://doi.org/10.1016/j.chest.2021.07.055
Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber S, Jenkins J, Kline J, Michaels A, Thistlethwaite P, Vedantham S, White R, Zierler B. Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension. Circulation. 2011;123(16):1788-1830. https://doi.org/10.1161/CIR.0b013e318214914f
Kaufman JA, Barnes GD, Chaer RA, Cuschieri J, Eberhardt R, Johnson M, Kuo W, Murin S, Patel S, Rajasekhar A, Weinberg I, Gillespie D. Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease. Journal of Vascular and Interventional Radiology. 2020;31(10):1529-1544. https://doi.org/10.1016/j.jvir.2020.06.014
Konstantinides S V, Meyer G, Becattini C, Bueno H, Geersing G, Harjola V, Huisman M, Humbert M, Jennings C, Jiménez D, Kucher N, Lang I, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano J, Galié N, Gibbs J, Aboyans V, Ageno W, Agewall S, Almeida A, Andreotti F, Barbato E, Bauersachs J, Baumbach A, Beygui F, Carlsen J, De Carlo M, Delcroix M, Delgado V, Subias P, Fitzsimons D, Gaine S, Goldhaber S, Gopalan D, Habib G, Halvorsen S, Jenkins D, Katus H, Kjellström B, Lainscak M, Lancellotti P, Lee G, Le Gal G, Messas E, Morais J, Petersen S, Petronio A, Piepoli M, Price S, Roffi M, Salvi A, Sanchez O, Shlyakhto E, Simpson I, Stortecky S, Thielmann M, Noordegraaf A, Becattini C, Bueno H, Geersing G, Harjola V, Huisman M, Humbert M, Jennings C, Jiménez D, Kucher N, Lang I, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, VanBelle E, LuisZamorano J, Windecker S, Aboyans V, Baigent C, Collet J, Dean V, Delgado V, Fitzsimons D, Gale C, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus H, Landmesser U, Leclercq C, Lettino M, Lewis B, Merkely B, Mueller C, Petersen S, Sonia Petronio A, Richter D, Roffi M, Shlyakhto E, Simpson I, Sousa-Uva M, Touyz R, Hammoudi N, Hayrapetyan H, Mascherbauer J, Ibrahimov F, Polonetsky O, Lancellotti P, Tokmakova M, Skoric B, Michaloliakos I, Hutyra M, Mellemkjaer S, Mostafa M, Reinmets J, Jääskeläinen P, Angoulvant D, Bauersachs J, Giannakoulas G, Zima E, Vizza C, Sugraliyev A, Bytyçi I, Maca A, Ereminiene E, Huijnen S, Xuereb R, Diaconu N, Bulatovic N, Asfalou I, Bosevski M, Halvorsen S, Sobkowicz B, Ferreira D, Petris A, Moiseeva O, Zavatta M, Obradovic S, Šimkova I, Radsel P, Ibanez B, Wikström G, Aujesky D, Kaymaz C, Parkhomenko A, Pepke-Zaba J. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. https://doi.org/10.1093/eurheartj/ehz405
Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, Ten Cate-Hoek AJ, Elalamy I, Enzmann FK, Geroulakos G, Gottsäter A, Hunt BJ, Mansilha A, Nicolaides AN, Sandset PM, Stansby G, Esvs Guidelines Committee, de Borst GJ, Bastos Gonçalves F, Chakfé N, Hinchliffe R, Kolh P, Koncar I, Lindholt JS, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, De Maeseneer MG, Comerota AJ, Gloviczki P, Kruip MJHA, Monreal M, Prandoni P, Vega de Ceniga. Editor’s Choice — European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82. https://doi.org/10.1016/j.ejvs.2020.09.023
Bokeriya LA, Zatevakhin II, Kirienko AI. Rossijskie Klinicheskie Rekomendatsii Po Diagnostike, Lecheniyu i Profilaktike Venoznykh Tromboehmbolicheskikh Oslozhnenij (VTEHO). Journal of Venous Disorders. 2015;9(4-2):11-12. (In Russ.).
Seliverstov EI, Lobastov KV, Ilyukhin EA, Apkhanova TV, Akhmetzyanov RV, Akhtyamov IF, Barinov VE, Bakhmetiev AS, Belov MV, Bobrov SA, Bozhkova SA, Bredikhin RA, Bulatov VL, Vavilova TV, Vardanyan AV, Vorobiev NA, Gavrilov EK, Gavrilov SG, Golovina VI, Gorin AS, Dzhenina OV, Dianov SV, Efremova OI, Zhukovets VV, Zamyatin MN, Ignatiev IA, Kalinin RE, Kamaev AA, Kaplunov OA, Karimova GN, Karpenko AA, Kasimova AR, Katelnitskaya OV, Katelnitsky II, Katorkin SE, Knyazev RI, Konchugova TV, Kopenkin SS, Koshevoy AP, Kravtsov PF, Krylov AYu, Kulchitskaya DB, Laberko LA, Lebedev IS, Malanin DA, Matyushkin AV, Mzhavanadze ND, Moiseev SV, Mushtin NE, Nikolaeva MG, Pelevin AV, Petrikov AS, Piradov MA, Pikhanova ZhM, Poddubnaya IV, Porembskaya OYa, Potapov MP, Pyregov AV, Rachin AP, Rogachevsky OV, Ryabinkina YuV, Sapelkin SV, Sonkin IN, Soroka VV, Sushkov SA, Schastlivtsev IV, Tikhilov RM, Tryakin AA, Fokin AA, Khoronenko VE, Khruslov MV, Tsaturyan AB, Tsed AN, Cherkashin MA, Chechulova AV, Chuiko SG, Shimanko AI, Shmakov RG, Yavelov IS, Yashkin MN, Kirienko AI, Zolotukhin IA, Stoyko YuM, Suchkov IA. Prevention, Diagnostics and Treatment of Deep Vein Thrombosis. Russian Experts Consensus. Journal of Venous Disorders. 2023;17(3):152-296. (In Russ.). https://doi.org/10.17116/flebo202317031152
Li X, Haddadin I, McLennan G, Farivar B, Staub D, Beck A, Thompson D, Partovi S. Inferior vena cava filter — comprehensive overview of current indications, techniques, complications and retrieval rates. Vasa. 2020;49(6): 449-462. https://doi.org/10.1024/0301-1526/a000887
Kornilov DY, Satinov A V., Abduzhalil G, Maksimov A V. Catheter-Directed Thrombolysis for Phlegmasia Cerulea Dolens. Journal of Venous Disorders. 2023;17(4):361-366. https://doi.org/10.17116/flebo202317041361
Lundh B, Fagher B. The Clinical Picture of Deep Vein Thrombosis Correlated to the Frequency of Pulmonary Embolism. Acta Med Scand. 2009;210(1-6): 353-356. https://doi.org/10.1111/j.0954-6820.1981.tb09830.x
Baldridge ED, Martin MA, Welling RE. Clinical significance of free-floating venous thrombi. J Vasc Surg. 1990;11(1):62-69. https://doi.org/10.1016/0741-5214(90)90329-9
Alhabouni S, Hingorani A, Ascher E, Marks N, Shiferson A, Patel N, Gopal K, Jacob T. PP88. Lower Extremity Occlusive vs Non-occlusive DVT and the Risk of Pulmonary Embolism. J Vasc Surg. 2009;49(5):S40. https://doi.org/10.1016/j.jvs.2009.02.118
Pacouret G, Alison D, Pottier JM, Bertrand P, Charbonnier B. Free-floating thrombus and embolic risk in patients with angiographically confirmed proximal deep venous thrombosis. A prospective study. Arch Intern Med. 1997;157(3):305-308.
Monreal M, Ruiz J, Salvador R, Morera J, Arias A. Recurrent Pulmonary Embolism. Chest. 1989;95(5):976-979. https://doi.org/10.1378/chest.95.5.976
Radomski JS, Jarrell BE, Carabasi RA, Yang SL, Koolpe H. Risk of pulmonary embolus with inferior vena cava thrombosis. Am Surg. 1987;53(2): 97-101.
Chernukha L, Khrebtiy Y, Khrebtii H. Danger of floating venous thrombosis: myth or reality? Phlebology: The Journal of Venous Disease. 2023;38(5): 322-333. https://doi.org/10.1177/02683555231169507
Zolotukhin IA, Arslanbekov MM, Efremova OI, Lebedev IS, Leontiev SG, Kirienko AI. Validity of Indications for Inferior Vena Cava Filter Placement in Patients with Venous Thromboembolism. Journal of Venous Disorders. 2021;15(2):80-86. (In Russ.). https://doi.org/10.17116/flebo20211502180
Lebedev IS, Gilyarov MYu, Efremova OI, Zolotukhin IA, Kirienko AI. Does the Use of Prognostic Scales and Clinical Guidelines Always Guarantee the Survival of Patients with Massive Pulmonary Embolism. Journal of Venous Disorder. 2022;16(1):23-28. (In Russ.). https://doi.org/10.17116/flebo20221601123
Golovina VI, Efremova OI, Zolotukhin IA. Treatment and Secondary Prevention of Venous Thromboembolic Events in Fragile Patients in a Real-life Practice. Journal of Venous Disorder. 2021;15(2):95-102. (In Russ.). https://doi.org/10.17116/flebo20211502195