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Br J Gen Pract. Sep 1, 2006; 56(530): 693–696.
PMCID: PMC1876636
Deep vein thrombosis in primary care: possible malignancy?
Ruud Oudega, MD, PhD, GP and Senior Researcher and Karel GM Moons, MSc, PhD, Professor of Clinical Epidemiology
Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, The Netherlands
H Karel Nieuwenhuis, MD, PhD, Internal Medicine
Department of Haematology, University Medical Center Utrecht, The Netherlands
Fred L van Nierop, MD, Internal Medicine
St Jansdal Hospital, Department of Internal Medicine, Harderwijk, The Netherlands
Arno W Hoes, MD, PhD, Professor of Clinical Epidemiology and General Practice
Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, The Netherlands
Address for correspondence Ruud Oudega, Julius Center for Health Sciences and Primary Care, University Medical Center, PO Box 85060, 3508 AB, Utrecht, The Netherlands. E-mail: R.Oudega/at/knmg.nl
Received August 8, 2005; Revised September 22, 2005; Accepted February 21, 2006.
Abstract
Background
The increased prevalence of unrecognised malignancy in patients with deep vein thrombosis (DVT) has been well established in secondary care settings. However, data from primary care settings, needed to tailor the diagnostic workup, are lacking.
Aim
To quantify the prevalence of unrecognised malignancy in primary care patients who have been diagnosed with DVT.
Design
Prospective follow-up study.
Setting
All primary care physicians affiliated/associated with a non-teaching hospital in a geographically circumscribed region participated in the study.
Method
A total of 430 consecutive patients without known malignancy, but with proven DVT were included in the study and compared with a control group of 442 primary care patients, matched according to age and sex. Previously unrecognised, occult malignancy was considered present if a new malignancy was diagnosed within 2 years following DVT diagnosis (DVT group) or inclusion in the control group. Patients with DVT were categorised in to those with unprovoked idiopathic DVT and those with risk factors for DVT (that is, secondary DVT).
Results
During the 2-year follow-up period, a new malignancy was diagnosed 3.6 times more often in patients with idiopathic DVT than in the control group (2-year incidence: 7.4% and 2.0%, respectively). The incidence in patients with secondary DVT was 2.6%; only slightly higher than in control patients.
Conclusion
Unrecognised malignancies are more common in both primary and secondary care patients with DVT than in the general population. In particular, patients with idiopathic DVT are at risk and they could benefit from individualised case-finding to detect malignancy.
Keywords: deep vein thrombosis, idiopathic, neoplasms, primary health care
Articles from The British Journal of General Practice are provided here courtesy of
Royal College of General Practitioners