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OBJECTIVES: Risk of acute lower extremity deep vein thrombosis (LE-DVT) and associated morbidity and mortality during hospitalization is well-characterized. We evaluated mortality risk associated acute LE-DVT diagnosed in outpatients.
METHODS: Outpatients with unilateral duplex ultrasounds positive for acute LE-DVT over a 2 year period were identified from a clinical vascular laboratory. Electronic medical records were queried to determine DVT pharmacotherapy, medical history, DVT location, and mortality. Mortality risk was evaluated using logistic regression.
RESULTS: 111 acute LE-DVT were identified in outpatients over 2 years. Initial treatment consisted of enoxaparin ± warfarin in 71 patients (64%) and anticoagulation with oral Xa inhibitors in 19 (17%), while 21 patients (19%) were managed with alternative treatments (including unfractionated heparin, thrombolysis, and/or inferior vena cava filter insertion). Mortality over a median follow up of 8.9 months was 12.6%, including 8/75 patients (10.7%) with proximal and 6/36 patients (16.7%) with calf DVT. Treatment type (classified as Xa inhibitors, enoxaparin ± warfarin, or alternative treatments) was associated with mortality, with increased risk specifically associated with alternative treatments (OR 6.6, 95% CI [1.8-23.8], P=0.004 vs. enoxaparin ± warfarin). No association between DVT location and mortality was observed.
CONCLUSIONS: Short-term mortality associated with outpatient acute LE-DVT is significant and similar between patients with calf vein versus proximal thrombosis. Alternative treatments were associated with significant higher mortality risk; further investigation is required to determine whether this risk reflects more severe presentation, contraindications to standard pharmacotherapy, or other factors.