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Varicose Veins and Incident VTE and PAD
Study Questions:
Are varicose veins associated with an increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), or peripheral artery disease (PAD)?
Methods:
The authors performed a retrospective cohort study using claims data from Taiwan’s National Health Insurance program. They included patients ages ≥20 years, pairing patients with varicose veins and propensity score matched controls between 2001 and 2013. The main outcome was a new diagnosis of DVT, PE, or PAD.
Results:
The authors paired 212,984 patients with varicose veins and 212,984 control patients. Over a mean follow-up of >7 years, development of DVT was higher in varicose vein patients than control patients (6.55 vs. 1.23 per 1,000 person-years; hazard ratio [HR], 5.30; 95% confidence interval [CI], 5.05-5.56). There was a similarly higher rate of PE (0.48 vs. 0.28 per 1,000 person-years; HR, 1.73; 95% CI, 1.54-1.94) and PAD (10.73 vs. 6.22 per 1,000 person-years; HR, 1.72; 95% CI, 1.68-1.77) in varicose vein patients as compared to the control patients.
Conclusions:
The authors concluded that patients with varicose veins are at significantly increased risk of incident DVT. They also concluded that patients with varicose veins may be at increased risk of incident PE and PAD, but note that unmeasured confounding factors may explain the study findings.
Perspective:
Many clinicians have recognized an association between the presence of varicose veins and the future development of DVT. This longitudinal study confirms that finding, with a more than five-fold increased risk of DVT among patients with varicose veins as compared to control patients. However, given the high prevalence of varicose veins and relatively low incidence of new DVT, medical prophylaxis against DVT is not recommended for every patient with varicose veins. Although the association between varicose veins and incident PAD is not as conclusive as that for incident DVT, the prevalence of PAD is higher than DVT. Therefore, clinicians should maintain a high index of suspicion for PAD, including asking patients about claudication symptoms and routinely palpating pedal pulses.
Keywords: Anticoagulants, Intermittent Claudication, Peripheral Arterial Disease, Prevalence, Primary Prevention, Pulmonary Embolism, Risk, Varicose Veins, Vascular Diseases, Venous Thromboembolism, Venous Thrombosis
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