FREE-FLOATING THROMBUS AND EMBOLIC RISK IN PATIENTS WITH ANGIOGRAPHICALLY CONFIRMED PROXIMAL DEEP VENOUS THROMBOSIS - A PROSPECTIVE-STUDY

Background: A free-floating thrombus (FFT) is often considered to be a risk factor for pulmonary embolism (PE), despite adequate anticoagula tion therapy, in patients with proximal deep venous thrombosis. Method s: Ninety-five patients underwent prospective assessment according to the presence (FFT group [n=62]) or absence (occlusive thrombus group [ n=28]) of an FFT. On day 1, color venous duplex scanning, venography ( reference method), perfusion lung scanning, and, if results of the lun g scan were abnormal, pulmonary angiography were performed. On day 10 (range, days 9-11), the lung scan was repeated, as well as pulmonary a ngiography if the lung scan demonstrated impairment. A 3-month clinica l follow-up visit was scheduled. Five patients were retrospectively ex cluded from analysis for uncertain diagnosis of FFT. Patients were tre ated with intravenous unfractionated heparin sodium adjusted for activ ated partial thromboplastin time (n=1) or subcutaneous low-molecular-w eight heparin (n=89) (nadroparin calcium, 225 Institut Choay factor Xa inhibitory units per kilogram for 12 hours). Warfarin sodium therapy was initiated on day 3 (range, days 2-4). Results: Both groups were we ll-matched according to age, sex, risk factors, and delay from onset o f symptoms to treatment. Positive and negative predictive values of co lor venous duplex scanning for the diagnosis of an FFT were 91% and 55 %, respectively. On admission, PE prevalence was 64% in the FFT group (40 of 62 patients) and 50% in the occlusive thrombus group (14 of 28 patients) (P=.19). Two patients were excluded on follow-up analysis (r ange, days 9-11) for preventive vena cava filtering (due to major blee ding in 1 and cholecystectomy in the other); the recurrent rate of PE was 3.3% in the FFT group (2 of 61 patients) and 3.7% in the occlusive thrombus group (1 of 27 patients). No symptomatic recurrent PE occurr ed between day 10 (range, days 9-11) and 3 months. Four patients died of evolutive neoplasm after hospital discharge. Conclusions: No higher risk for PE was observed in patients with free-floating proximal deep venous thrombosis; anticoagulant therapy should prevent recurrent PE in such patients.