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Venous insufficiency symptoms predict thrombosis in older patients
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Clinical features of venous insufficiency — such as varicose veins, leg ulcers and leg edema — served as risk factors for venous thrombosis in older adults, according to the results of a case-control population study.
“The incidence of venous thrombosis increases steeply with age, with an incidence of 0.5% to 1% per year in people aged over 70 years,” Astrid van Hylckama Vlieg, PhD, assistant professor in the department of clinical epidemiology at Leiden University Medical Center in the Netherlands, and colleagues wrote. “More than 60% of all thrombotic events occur in this age group.”
Stasis of blood flow contributes to the development of thrombosis and may be due to venous insufficiency in the legs, according to the researchers.
Van Hylckama Vlieg and colleagues conducted the Age and Thrombosis Acquired and Genetic risk factors in the Elderly (AT-AGE) study to determine whether clinical features of venous insufficiency served as risk factors for venous thrombosis in patients aged 70 years or older.
Between 2008 and 2011, the researchers identified all consecutive cases of deep vein thrombosis in the leg or pulmonary embolism in older patients at two treatment centers in Leiden, Netherlands, and one treatment center in Burlington, Vermont.
The study included data from 401 patients with a first-time venous thrombosis and 431 controls.
A greater proportion of patients than controls had varicose veins (32.7% vs. 21.6%), a history of leg ulcers (8.7% vs. 2.6%) and leg edema (33% vs. 13.9%).
In analyses adjusted for age, sex and study center, varicose veins increased the risk for thrombosis 1.6-fold (OR = 1.6; 95% CI, 1.2-2.3), leg ulcers increased the risk 3.3-fold (OR = 3.3; 95% CI, 1.6-6.7), and leg edema increased the risk threefold (OR = 3; 95% CI, 2.1-4.5).
The highest risk for thrombosis arose when all three risk factors occurred simultaneously. Eight patients vs. one control experienced all three risk factors, equating to a 10.5 increased risk for thrombosis (adjusted OR = 10.5; 95% CI, 1.3-86.1).
DVT alone occurred in 41% (n = 166) of patients and PE with or without DVT occurred in 59% (n = 235) of patients. Similar venous insufficiency risk factors appeared for both types of thrombosis; however, the association appeared strongest between leg ulcers and the risk for DVT (adjusted OR = 4.3; 95% CI, 2-9.4).
“This gives further insight into the etiology of venous thrombosis in this older population,” van Hylckama Vlieg and colleagues wrote. “Physicians may be more alert for thrombosis when one of the clinical features of venous insufficiency is present as these contribute to the burden of venous thrombosis in this older patient group.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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