Determinants of health‐related quality of life during the 2 years following deep vein thrombosis

Abstract

Summary. Background/objectives: We prospectively measured change in quality of life (QOL) during the 2 years after a diagnosis of deep vein thrombosis (DVT) and evaluated determinants of QOL, including development of the postthrombotic syndrome (PTS). Patients/methods: Consecutive patients with acute DVT were recruited from 2001 to 2004 at eight hospitals in Canada. At study visits at baseline, and 1, 4, 8, 12 and 24 months, clinical data were collected, standardized PTS assessments were performed, and QOL questionnaires were self-completed. Generic QOL was measured using the Short-Form Health Survey-36 (SF-36) questionnaire. Venous disease-specific QOL was measured using the Venous Insufficiency Epidemiological and Economic Study (VEINES)-QOL/ Sym questionnaire. The change in QOL scores over a 2-year follow-up was assessed. The influence of PTS and other characteristics on QOL at 2 years was evaluated using multivariable regression analyses. Results: Among the 387 patients recruited, the average age was 56 years, two-thirds were outpatients, and 60% had proximal DVT. The cumulative incidence of PTS was 47%. On average, QOL scores improved during follow-up. However, patients who developed PTS had lower scores at all visits and significantly less improvement in QOL over time (P-values for PTS*time interaction were 0.001, 0.012, 0.014 and 0.006 for PCS, MCS, VEINES-QOL and VEINES-Sym). Multivariable regression analyses showed that PTS (P < 0.0001), age (P = 0.0009), proximal DVT (P = 0.01) and inpatient status (P = 0.04) independently predicted 2-year SF-36 PCS scores. PTS alone independently predicted 2-year VEINES-QOL (P < 0.0001) and VEINESSym (P < 0.0001) scores. Conclusions: Development of PTS is the principal determinant of health-related QOL 2 years after DVT. Our study provides prognostic information on patientreported outcomes after DVT and emphasizes the need for effective prevention and treatment of the PTS.

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

“…[4] If not fatal, untreated venous thromboembolism (VTE) may have serious consequences such as risk of recurrent VTE, [1] postthrombotic syndrome, [1] chronic thromboembolic pulmonary hypertension [5] and reduced quality of life. [6] The prevalence of VTE and the use of pharmacological thromboprophylaxis in total hip replacement (THR), total knee replacement (TKR) and hip fractures have been well documented in published literature and in clinical trials. [1,[7][8][9][10] Although there is potentially an increased risk of VTE in foot and ankle surgery, the incidence of VTE is poorly understood.…”

“…Although the majority of recent studies do not advocate the routine use of chemoprophylaxis in foot and ankle surgery, [6,12,13,21,22,25,27,30,33,[38][39][40] several authors recommend its use in patients with identifiable specific clinical risk factors. [6,[8][9][10][11][12][13][14][15][16][17][18][19][20]26,37,41] A difficulty of long-term follow-up of patients is that many DVT events occur several weeks or longer after discharge.…”

“…[6,[8][9][10][11][12][13][14][15][16][17][18][19][20]26,37,41] A difficulty of long-term follow-up of patients is that many DVT events occur several weeks or longer after discharge. [37,42] …”

Deep Vein Thrombosis Interventions in Cancer Patients

“…29 In fact, 2 years post-DVT, the development of PTS remained the primary determinant of health-related QOL scores. 30 Given this significant risk of PTS in the cancer population and potentially adverse effects, consideration for aggressive treatment should be given to all DVT patients, including those with cancer. Evaluation and treatment planning should be centered on QOL and the potential for improvement.…”

Genotyping of <i>CYP2C9</i> and <i>VKORC1</i> polymorphisms predicts south Indian patients with deep vein thrombosis as fast metabolizers of warfarin/acenocoumarin

“…A number of various family and twin studies have revealed that genetic factors account for more than 60% of the risk for developing DVT (26,27). Regardless of ideal traditional treatment strategies with anticoagulants, a post-thrombotic syndrome often develops in one in four patients within a year while DVT recurs in one-third of patients within five years (28,29).…”