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Adults with varicose veins are at increased risk of DVT
Clinical Question
Are adults with varicose veins at an increased risk of deep vein thrombosis, pulmonary embolus, or peripheral arterial disease?
Bottom line
Adults with varicose veins are at an increased risk of deep vein thrombosis (DVT). The risk is highest in patients aged 20 years to 34 years. The risks of pulmonary embolus (PE) and peripheral arterial disease (PAD) are still uncertain because of potential confounding variables. 2b-
Reference
Study design: Cohort (retrospective)
Funding: Foundation
Setting: Population-based
Synopsis
These investigators assessed data obtained from multiple national registries in Taiwan about patients given a diagnosis of varicose veins using standard international diagnostic criteria from January 2001 through December 2013. Exclusion criteria included being younger than 20 years at diagnosis or having a history of PAD, DVT, or PE. A control group of patients without varicose veins were matched with those in the varicose vein group at a 4:1 ratio based on year of birth, sex, and potential confounders (including hypertension, diabetes, chronic obstructive pulmonary disease, malignancy, heart failure, stroke, and chronic renal disease, among others). To control for potential unobserved confounders, the investigators also performed a negative control exposure using hemangioma as a condition similar to varicose veins but unlikely to cause VTE. Similarly, they used 2 falsification end points—lung cancer and hyperlipidemia—that are known not to be associated with varicose veins. A total of 212,984 patients with a mean age of 54.5 years (69.3% were women) served as cases with varicose veins with a median follow-up time from 7.3 to 7.8 years. The incidence of DVT was significantly higher among patients with varicose veins than among control patients (6.55 vs 1.23 per 1000 person-years; absolute risk difference 5.32; 95% CI 5.18 -5.46). The risk was greatest among patients aged 20 to 34 years; risk decreased with increasing age. The incidence of PE and PAD was also significantly increased among patients with varicose veins than without, but the difference no longer remained significant after analysis for potential unmeasured confounders. As expected, hemangioma was not significantly associated with an increased risk of DVT, PE, or PAD, and there was only a weak association of varicose veins with hyperlipidemia and lung cancer.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
dvt and varicose veins
does this raise the possibility that 20-34 years old with varicose veins are a higher risk for other reasons? That is early for significant varicose veins?
Missing stratification of CVI in this study combined with BMI
It will be helpful to study further whether treating or managing the varicosities ( medical or surgical ) will impact the outcome.
This is interesting. While I had been taught that there is a higher incidence of DVT/PE in patients with Varicose Veins, this article sheds a particular light on where and when the concerns need to be maximal. It also may mean that it would be wise to use anticoagulation when such patients travel to decrease the potential for DVTs and PEs.
Hm... I wonder whether such patients should not be on low dose ASA...
good poem
Real outcomes of pe and mortality and hospital admission are really the things we worry about. Asymptomatic vs symptomatic dvt? Hopefully, another trial would be helpful...
Excellent