Incidence and interventions for post-thrombotic syndrome

Farrell, Jeffrey; Sutter, Christopher; Tavri, Sidhartha; Patel, Indravadan

doi:10.21037/cdt.2016.11.22

Cited by 45 publications

(69 citation statements)

References 46 publications

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“…Depending on DVT location, venous bypass is promising, but there are no randomized controlled studies comparing operative versus conservative treatment . Other surgical options include foam sclerotherapy, venous stripping, and radiofrequency or laser ablation . A emerging treatment modality is percutaneous transdermal recanalization of the iliac venous outflow tract by stent angioplasty.…”

Section: Invasive Treatment Of Ptsmentioning

confidence: 99%

Chronic complications of venous thromboembolism

Winter

Schernthaner

Lang

2017

Journal of Thrombosis and Haemostasis

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Venous thromboembolism (VTE) is a common disease (~700 per 100 000) that is associated with significant risk of recurrence, chronic complications, and substantial mortality, with reported death rates of up to 40% at 10 years. The development of novel anticoagulants has revolutionized the treatment of acute VTE, while strategies for prevention and treatment of chronic complications still seek for such a landmark change. Impaired thrombus resolution is the common denominator behind VTE complications, which are postthrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (CTEPH). PTS and CTEPH are associated with substantial morbidity and high healthcare expenses. While PTS occurs in up to 50% of patients after symptomatic deep vein thrombosis, only a small and poorly defined number of patients are diagnosed with CTEPH after pulmonary embolism. This review is a comprehensive summary of VTE-related chronic complications, their epidemiology, diagnosis, and treatment.

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Section: Invasive Treatment Of Ptsmentioning

confidence: 99%

Chronic complications of venous thromboembolism

Winter

Schernthaner

Lang

2017

Journal of Thrombosis and Haemostasis

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“…The incidence of post thrombotic syndrome (PTS) ranged from 20% to 50%, and is most frequently associated with iliofemoral venous thrombosis. 1,2 The conventional treatment of acute DVT aims to prevent thrombus propagation and to reduce the risks of PE and DVT recurrence. 3 However, this treatment is ineffective at reducing thrombus burden and consequently does not prevent PTS.…”

Section: Introductionmentioning

confidence: 99%

The effect of Angiojet rheolytic thrombectomy in the endovascular treatment of lower extremity deep venous thrombosis

Dumantepe

Uyar

2017

Phlebology

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Objective To evaluate the clinical safety and effectiveness of percutaneous rheolytic thrombectomy in patients with acute lower extremity deep venous thrombosis. Method Sixty-eight consecutive patients with acute massive lower extremity deep venous thrombosis were included in this retrospective study. A percutaneous rheolytic thrombectomy device (Angiojet ® Rheolytic thrombectomy catheter, Boston Scientific, Marlborough, MA, USA) was used in all patients in an angiography suite through ipsilateral popliteal vein access. Thrombus clearance and complications were evaluated. Furthermore, patients underwent a clinical evaluation according to a modified Villalta scale for the investigation of post thrombotic syndrome in follow-up. The Venous Clinical Severity Score, Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Sym questionnaires were completed preoperatively and readministered postoperatively. Results Overall thrombus clearance (complete recanalization was achieved in 58 patients (85.2%) and partial recanalization was achieved in 7 patients (10.2%) confirmed through venographic assessment was achieved in 95.5% of the patient population. The mean Venous Clinical Severity Score preoperatively was 13.1 ± 2.2 and decreased to 4.0 ± 1.3 postoperatively (P < 0.01). The Villalta scale dropped from 12.9 ± 2.8 to 5.5 ± 1.4 postoperatively (P < 0.001). Overall quality of life and symptoms improved as assessed by Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Sym (P < 0.01 and 0.02, respectively). Only three minor bleedings were seen but none of the patients suffered from major bleeding, symptomatic pulmonary embolism, death, or other procedure related complications. Fifty-nine out of 65 patients (90.7%) who were treated successfully with rheolytic thrombectomy remained patent at 12 months according to DUS and five patients (7.3%) developed a mild post thrombotic syndrome. Conclusion Rheolytic thrombectomy with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. This technique is a safe, effective and easily performed method of endovascular treatment with a low rate of major treatment complications and shows promising clinical mid-term results.

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“…2 Previously reported incidence rates for VTE after ATR, presenting as deep vein thrombosis (DVT) or pulmonary embolism (PE), range from less than 1% to 52% irrespective of treatment modality, and these conditions carry a high risk of morbidity and mortality. ¶ For example, 20% to 50% of patients with VTE develop postthrombotic syndrome, which can lead to chronic leg ulcers, 11 pain, and reduced physical capability. Furthermore, postthrombotic syndrome is a major cause of lost workdays and decreased quality of life.…”

mentioning

confidence: 99%

Symptomatic Venous Thromboembolism After Achilles Tendon Rupture: A Nationwide Danish Cohort Study of 28,546 Patients With Achilles Tendon Rupture

et al. 2019

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Background: Venous thromboembolism (VTE) is a well-known complication of Achilles tendon rupture (ATR) and carries a high risk of morbidity and mortality. Although routine thromboprophylaxis for patients with ATR is not recommended, sparse knowledge is available regarding risk factors associated with VTE in patients with ATR. Purpose: To use Danish nationwide registers to identify incidence rates for symptomatic VTE and risk factors associated with increased risk of developing VTE in patients with ATR. Study Design: Cohort study; Level of evidence, 3. Methods: By crosslinking nationwide registers, we identified all patients with diagnosed ATR in Denmark from 1997 to 2015. We stratified patients into 4 groups by age and treatment modality (ie, operative vs nonoperative treatment). The main outcome was VTE within 180 days. We calculated crude incidence rates and considered age, sex, year, comorbidities, and medications as risk factors for VTE in Poisson regression models. Results: We identified 28,546 patients with ATR, of whom 389 (1.36%) were hospitalized with VTE during the follow-up period: 278 due to deep vein thromboses and 138 due to pulmonary embolism. Incidence rates were highest during the first month and ranged from 4.6 to 14.6 events per 100 person-years. VTEs were most frequent among nonoperatively treated patients aged ≥50 years. In Poisson regression analyses, having had VTE beforehand was associated with an increased risk of VTE, as was male sex in the nonoperative treatment group aged ≥50 years; among women <50 years of age, hormonal contraceptives led to a 4- to 6-fold higher risk of VTE compared with patients in the same group without the equivalent risk factor. Conclusion: In this nationwide cohort of patients with ATR, 1.36% developed symptomatic VTE during follow-up. Hormonal contraception, previous VTE, older age group, and male sex increased the risk of VTE. Taken together, the results of the present study suggest that focus on risk stratification and initiatives to prevent VTE might be warranted. A randomized controlled trial could answer this question.

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Incidence and interventions for post-thrombotic syndrome

Cited by 45 publications

References 46 publications

Chronic complications of venous thromboembolism

Chronic complications of venous thromboembolism

The effect of Angiojet rheolytic thrombectomy in the endovascular treatment of lower extremity deep venous thrombosis

Symptomatic Venous Thromboembolism After Achilles Tendon Rupture: A Nationwide Danish Cohort Study of 28,546 Patients With Achilles Tendon Rupture

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