Geersing, G-J., Cazemier, S., Rutten, F. H., Fitzmaurice, David A. and Hoes, A. W. (2018) Incidence of superficial venous thrombosis in primary care and risk of subsequent venous thromboembolic sequelae : a retrospective cohort study performed with routine healthcare data from the Netherlands. BMJ Open, 8 . e019967. doi:10.1136/bmjopen-2017-019967 ISSN 2044-6055.

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Abstract

Objectives

Recent studies in referred populations of superficial venous thrombosis (SVT) patients report risks of venous thrombo-embolic (VTE) sequela (deep vein thrombosis or pulmonary embolism) as high as 25%. Likely, these estimates are lower in non-referred patients but large-scale population-based studies are lacking. We aimed to estimate the incidence rate of SVT in primary care and quantify its risk of VTE-sequela.

Design

A retrospective cohort study, using International Classification of Primary Care coding (K94.02) combined with free-text searching (synonyms for SVT) to capture all SVT-events. All patients were followed-up for 3 months using manual free-text searching.

Setting

Primary care.

Participants

All patients enlisted with general practitioners within the Utrecht General Practitioner Network between 2010 and 2016 (1,534,845 person-years follow-up).

Main outcome measures

The incidence rate of SVT was expressed as the number of SVT-events per 1000 person-years of follow-up and the 3-month cumulative incidence of VTE-events was calculated. Logistic regression analysis was used to compare SVT patients with and without VTE-sequela.

Results

A total of 2,008 SVT cases were identified, i.e. a SVT incidence rate of 1.31 (95% CI 1.25 to 1.37) per 1000 person-years follow-up, with higher rates notably with increasing age. VTE sequela occurred in 83 patients; 51 at the time of SVT diagnosis and 32 patients during follow-up (total cumulative incidence of 4.1%; 95% CI 3.3% to 5.1%), and were more frequent in those with an active malignancy (OR 2.19; 95% 0.97 to 4.95) and less frequent in those with varicose veins at baseline (OR 0.57, 95% CI 0.34 to 0.94).

Conclusion

We found an incidence rate of SVT in primary care of 1.31 per 1000 person-years. The risks of VTE sequela was relatively low at 4.1%, with the highest risk in cancer patients and in those who experience a SVT in the absence of varicose veins.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Thrombophlebitis -- Netherlands, Diseases -- Complications -- Netherlands, Primary care (Medicine) -- Netherlands
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	20 April 2018
Dates:	Date Event 20 April 2018 Published 3 April 2018 Accepted
Volume:	8
Article Number:	e019967
DOI:	10.1136/bmjopen-2017-019967
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	5 April 2018
Date of first compliant Open Access:	12 June 2018
Related URLs:	Publisher

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