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27-06-2011 | Cardiology | Article

Fever linked to worse DVT outcome

Abstract

Free abstract

MedWire News: Patients with deep vein thrombosis (DVT) and fever at presentation are twice as likely to die within a month than those without fever, findings from the RIETE registry show.

The RIETE (Registro Informatizado de Enfermedad TromboEmbólica) initiative is an ongoing, observational registry, designed to gather data on the clinical characteristics, treatment patterns, and outcome in consecutive patients with symptomatic, objectively confirmed, acute venous thromboembolism (DVT and pulmonary embolism [PE]).

In the present study, Raquel Barba (Fundación Hospital Alcorcón, Madrid, Spain) and colleagues used RIETE data to assess the prevalence of fever in patients with acute DVT, and to investigate whether fever might be associated with a worse outcome during the first month of therapy.

As of September 2009, 14,480 patients with symptomatic DVT had been enrolled in RIETE. Of these, 707 (4.9%) had fever at presentation.

During the 30-day study period, 448 patients (3.1%) died, 171 (1.2%) developed DVT recurrences, 376 (2.6%) had pulmonary embolism, and 384 (2.6%) had a major bleed.

Patients initially presenting with fever had significantly higher mortality than those without (5.8 vs 2.9%) and an increased incidence of DVT recurrence (2.1 vs 1.1%).

Multivariate analysis confirmed that DVT patients with fever were twice as likely to die within 30 days as those without fever, irrespective of age, body weight, and risk factors for VTE.

Barba and co-authors speculate that the excess mortality in the group with fever was mostly due to an increased incidence of fatal PE or infection. Indeed, PE and infection were significantly more common in patients presenting with fever than in those without fever, at 0.7% and 1.1% versus 0.1% and 0.3%, respectively.

The researchers note that the RIETE registry provides insights into the natural history of VTE because of its unselected patient population.

Thus, the worse outcome associated with fever in this study may reflect pre-existing, unrecognized disease processes, or be secondary to a malignancy or the coexistence of an infection, they write.

They conclude by recommending that "DVT patients presenting with fever should be closely monitored."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Laura Dean

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