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Residual Venous Thrombosis and Recurrent Thromboembolism
- Paolo Prandoni, MD, PhD;
- Anthonie W.A. Lensing, MD, PhD; and
- Martin H. Prins, MD, PhD
- University of Padua; 35128 Padua, Italy (Prandoni) University of Amsterdam; Amsterdam, the Netherlands (Lensing) University of Maastricht; Maastricht, the Netherlands (Prins)
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IN RESPONSE:
Regarding the comments of Drs. Sebastian and Torre, we would like to state that all of our patients received an initial course of therapeutic dosages of low-molecular-weight heparin followed by vitamin K antagonists, monitored intensively to maintain the INR between 2.0 and 3.0. However, despite specialized anticoagulation clinics and optimal, dedicated physician care, subtherapeutic INRs are encountered approximately 20% of the time. Currently, we are not aware of any routinely used strategy to improve the percentage of time spent in the therapeutic range and counteract the potential detrimental effect of subtherapeutic INRs.
We agree with Drs. Emmerich and Fiessinger that the assessment of venous reflux is much less reproducible than compression ultrasonography. We also agree that our results need confirmation before implementation in daily routine, since prognostic associations do not necessarily translate into causal relationships. However, it should be noted that our results are fully consistent with the recent results of a study by another group (1). The observation that patients with residual venous thrombosis are as likely to develop ipsilateral as contralateral venous thrombosis suggests that residual venous thrombosis is not the cause in itself but is merely a marker (as a result of underlying hypercoagulability?) for subsequent venous thromboembolism. Indeed, it would be ideal to widely adopt a consensus classification for the description of the various subpopulations in venous thrombosis, but we view this as a difficult task to achieve because of the ongoing evolution of insights in etiology and pathogenesis.
To Dr. Rajput, we would like to reiterate that our study did not evaluate the compressed vein diameters at presentation of the acute episode but reported on the presence of residual thrombosis after months of anticoagulation and its association with subsequent recurrent venous thromboembolism.
Anthonie W.A. Lensing, MD, PhD
University of Amsterdam; Amsterdam, the Netherlands
Martin H. Prins, MD, PhD
University of Maastricht; Maastricht, the Netherlands
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
