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Asymptomatic Deep Vein Thrombosis is Associated with an Increased Risk of Death: Insights from the APEX Trial.

Publication ,  Journal Article
Kalayci, A; Gibson, CM; Chi, G; Yee, MK; Korjian, S; Datta, S; Nafee, T; Gurin, M; Haroian, N; Qamar, I; Hull, RD; Hernandez, AF; Cohen, AT ...
Published in: Thromb Haemost
December 2018

AIM:  Asymptomatic deep vein thrombosis (DVT) diagnosed with compression ultrasound (CUS) is a common endpoint in trials assessing the efficacy of anticoagulants to prevent venous thromboembolism (VTE), but the relationship of asymptomatic thrombus to mortality remains uncertain. METHODS:  In the APEX trial (ClinicalTrials.gov: NCT01583218), 7,513 acutely ill hospitalized medical patients were randomly assigned to extended-duration betrixaban (35-42 days) or enoxaparin (10 ± 4 days). Asymptomatic DVT was assessed once with CUS between day 32 and 47, and mortality was assessed through 77 days. RESULTS:  A total of 309 asymptomatic DVTs were detected through CUS. Of these, 133 (4.27%) subjects were in the betrixaban group, and 176 (5.55%) subjects were in the enoxaparin group (relative risk = 0.77, 95% confidence interval [CI] = 0.62-0.97, p = 0.025, number needed to treat = 79). With respect to all-cause mortality due to cardiovascular diseases, non-cardiovascular diseases and unknown causes, the number of the deaths was 5 (1.67%), 4 (1.34%) and 1 (0.33%) in the asymptomatic DVT group and 25 (0.42%), 33 (0.56%) and 11 (0.19%) in the no DVT group, respectively. Subjects with an asymptomatic DVT had an almost threefold increase in the risk of all-cause mortality compared with subjects without DVT (hazard ratio = 2.87, 95% CI = 1.48-5.57, p = 0.001). A positive linear trend was observed between greater thrombus burden and mortality during the follow-up (p = 0.019). CONCLUSION:  Asymptomatic DVT was associated with approximately threefold increased risk of short-term all-cause mortality in patients hospitalized with an acute medical illness within the prior 77 days. A positive linear trend was observed between greater thrombus burden and mortality during the follow-up.

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Published In

Thromb Haemost

DOI

EISSN

2567-689X

Publication Date

December 2018

Volume

118

Issue

12

Start / End Page

2046 / 2052

Location

Germany

Related Subject Headings

  • Venous Thrombosis
  • Venous Thromboembolism
  • United States
  • Survival Analysis
  • Risk
  • Pyridines
  • Proportional Hazards Models
  • Male
  • Humans
  • Female
 

Citation

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Kalayci, A., Gibson, C. M., Chi, G., Yee, M. K., Korjian, S., Datta, S., … Goldhaber, S. Z. (2018). Asymptomatic Deep Vein Thrombosis is Associated with an Increased Risk of Death: Insights from the APEX Trial. Thromb Haemost, 118(12), 2046–2052. https://doi.org/10.1055/s-0038-1675606
Kalayci, Arzu, C Michael Gibson, Gerald Chi, Megan K. Yee, Serge Korjian, Sudarshana Datta, Tarek Nafee, et al. “Asymptomatic Deep Vein Thrombosis is Associated with an Increased Risk of Death: Insights from the APEX Trial.Thromb Haemost 118, no. 12 (December 2018): 2046–52. https://doi.org/10.1055/s-0038-1675606.
Kalayci A, Gibson CM, Chi G, Yee MK, Korjian S, Datta S, et al. Asymptomatic Deep Vein Thrombosis is Associated with an Increased Risk of Death: Insights from the APEX Trial. Thromb Haemost. 2018 Dec;118(12):2046–52.
Kalayci, Arzu, et al. “Asymptomatic Deep Vein Thrombosis is Associated with an Increased Risk of Death: Insights from the APEX Trial.Thromb Haemost, vol. 118, no. 12, Dec. 2018, pp. 2046–52. Pubmed, doi:10.1055/s-0038-1675606.
Kalayci A, Gibson CM, Chi G, Yee MK, Korjian S, Datta S, Nafee T, Gurin M, Haroian N, Qamar I, Hull RD, Hernandez AF, Cohen AT, Harrington RA, Goldhaber SZ. Asymptomatic Deep Vein Thrombosis is Associated with an Increased Risk of Death: Insights from the APEX Trial. Thromb Haemost. 2018 Dec;118(12):2046–2052.
Journal cover image

Published In

Thromb Haemost

DOI

EISSN

2567-689X

Publication Date

December 2018

Volume

118

Issue

12

Start / End Page

2046 / 2052

Location

Germany

Related Subject Headings

  • Venous Thrombosis
  • Venous Thromboembolism
  • United States
  • Survival Analysis
  • Risk
  • Pyridines
  • Proportional Hazards Models
  • Male
  • Humans
  • Female