Sex-specific differences in the distal versus proximal presenting location of acute deep vein thrombosis

  • Alice Trinchero
    Affiliations
    Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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  • Luuk J.J. Scheres
    Affiliations
    Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

    Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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  • Jürgen H. Prochaska
    Affiliations
    Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

    Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

    German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Mainz, Germany

    Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Germany
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  • Chiara Ambaglio
    Affiliations
    Department of Internal Medicine, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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  • Philipp S. Wild
    Affiliations
    Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

    Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

    German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Mainz, Germany

    Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Germany
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  • Saskia Middeldorp
    Affiliations
    Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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  • Stavros V. Konstantinides
    Affiliations
    Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

    Department of Cardiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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  • Stefano Barco
    Correspondence
    Corresponding author at: Center for Thrombosis and Hemostasis, Johannes Gutenberg University, 403-131, Langenbeckstraße 1, 55131 Mainz, Germany.
    Affiliations
    Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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      Highlights

      • The proportions of pulmonary embolism versus proximal deep vein thrombosis (DVT) events differ between sexes.
      • We investigated whether the distal versus proximal presenting location of isolated DVT is influenced by sex.
      • Women presented with distal DVT more often than men, whereas men had more often proximal DVT.
      • This pattern appeared to depend on age and the absence of provoking risk factors, but further studies are warranted.

      Abstract

      Background and aims

      Women present with pulmonary embolism (PE) more often than men, while the opposite is true for proximal deep vein thrombosis (DVT). We investigated whether sex-specific differences exist in the presenting location of acute symptomatic DVT among patients without concomitant PE.

      Methods

      We tested our hypothesis in a meta-analysis of studies selected by systematically reviewing PubMed, Embase, and the grey literature. Thereafter, we analysed data of a single-center cohort including patients with first isolated acute DVT to assess the additional impact of age and provoking risk factors on the presenting location of DVT.

      Results

      We identified 7 studies for a total of 20,534 patients. The weighed pooled absolute difference in the proportion of distal DVT between women and men was +5.4% (95%CI: +0.7%; +9.5%), which corresponds to a pooled odds ratio (OR) of 1.30 (95%CI: 1.07–1.58). This difference was +6.5% (95%CI: +2.1%; +10.9%) for first distal DVT (OR 1.38; 95%CI: 1.11–1.72) and +5.3% (95%CI: +0.5%; +10.0%) for either first or recurrent distal DVT (OR 1.29; 95%CI: 1.03–1.61). In the cohort study, the larger difference in the proportion of distal DVT between women and men was observed among patients aged 51–70 (+9.5%; 95CI: +2.8%; +16.0% compared to those aged 18–50) or with unprovoked events (+8.5%; 95CI: −0.9%; +17.9%).

      Conclusions

      Among patients with first symptomatic isolated acute DVT, women presented with distal DVT more often than men, whereas men had a higher proportion of proximal DVT events. This pattern appeared to depend on age and the absence of provoking risk factors for VTE.

      Keywords

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