Long-term Risk of Postthrombotic Syndrome After Symptomatic Distal Deep Vein Thrombosis: The CACTUS-PTS Study

Galanaud, Jean‐Philippe; Righini, Marc; Collen, L. Le; Douillard, Aymeric; Robert‐Ebadi, Helia; Pontal, Daniel

doi:10.1016/j.jvsv.2020.04.012

Cited by 9 publications

(11 citation statements)

References 15 publications

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“…In the recently published prospective CACTUS-PTS-study the long-term risk to develop moderate or severe postthrombotic syndrome after symptomatic distal deep vein thrombosis (VS ! 10) was 7% after 6 years of follow up [25] and was therefore not much different to our findings although focusing on distal DVT.…”

Section: Discussioncontrasting

confidence: 81%

Incidence and severity of postthrombotic syndrome after iliofemoral thrombosis – results of the Iliaca-PTS – Registry

Nawasrah

Zydek

Lucks

et al. 2021

Vasa

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Summary: Background: Deep venous thrombosis (DVT) and in particular, iliofemoral thrombosis (IFT) can lead to recurrent thrombosis and postthrombotic syndrome (PTS). Data on the prevalence, predictors and outcome of IFT are scarce. Patients and methods: We retrospectively searched our database of outpatients who had presented with DVT and IFT including the iliac veins from 2014 until 2017. In addition, we performed a prospective registry in a subgroup of patients with IFT. These patients received duplex ultrasound, magnetic resonance venography and measurement of symptom-free walking distance using a standardized treadmill ergometry. The severity of PTS was analyzed using the Villalta-Scale (VS) and quality of life was assessed using the VEINES-QOL/Sym Questionnaire. Results: 847 patients were retrospectively identified with DVT and 19.7% (167/847) of these presented with IFT. 50.9% (85/167) of the IFT-patients agreed to participate in the prospective registry. The majority of these patients (76.5%: 65/85) presented with left-sided IFT. In 53.8% (35/65) May-Thurner syndrome was suspected. 27.1% (23/85) underwent invasive therapy. Moderate or severe PTS (VS ≥ 10) occurred in 10.6% (9/85). The severity of PTS is correlated with a reduced quality of life (ρ (CI 95%) = −0.63 (−0.76; −0.46); p < 0.01). None of the patients presented with a venous ulcer at any time. A high body mass index was a significant predictor (OR (CI 95%) = 1.18 (1.05; 1.33), p = 0.007) for the development of clinically relevant PTS (VS ≥ 10) and venous claudication. Conclusions: Every fifth patient with DVT presented with an IFT. The majority developed left sided IFT. Every 10th patient developed moderate or severe PTS (VS ≥ 10). A high body mass index was predictive for the development of PTS and venous claudication.

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Section: Discussioncontrasting

confidence: 81%

Incidence and severity of postthrombotic syndrome after iliofemoral thrombosis – results of the Iliaca-PTS – Registry

Nawasrah

Zydek

Lucks

et al. 2021

Vasa

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“…Another study found that the odds ratio of developing PTS was 1.94 (1.13-3.01) in patients with subtherapeutic INR values within the first 3 months of treatment [16]. Although we would no longer be able to randomize anticoagulation against placebo in an acute proximal DVT treatment trial, a recent RCT included 178 patients with distal DVT and randomized them to either therapeutic LMWH (nadroparin) or placebo for 6 weeks [17]. It showed that in the subgroup of patients without evidence of primary 4…”

Section: Effectiveness Of Anticoagulation For Preventing Pts After Dvtmentioning

confidence: 99%

Prevention of the Postthrombotic Syndrome with Anticoagulation: A Narrative Review

et al. 2021

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The post thrombotic syndrome (PTS) is chronic venous insufficiency secondary to a prior deep vein thrombosis (DVT). It is the most common complication of VTE and, while not fatal, it can lead to chronic, unremitting symptoms as well as societal and economic consequences. The cornerstone of PTS treatment lies in its prevention after DVT. Specific PTS preventative measures include the use of elastic compression stockings (ECS) and pharmacomechanical catheter directed thrombolysis (PCDT). However, the efficacy of these treatments has been questioned by large RCTs. So far, anticoagulation, primarily prescribed to prevent DVT extension and recurrence, appears to be the only unquestionably effective treatment for the prevention of PTS. In this literature review we present pathophysiological, biological, radiological and clinical data supporting the efficacy of anticoagulants to prevent PTS and the possible differential efficacy among available classes of anticoagulants (vitamin K antagonists (VKA), low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs)). Data suggest that LMWHs and DOACs are superior to VKAs, but no head-to-head comparison is available between DOACs and LMWHs. Owing to their potentially greater anti-inflammatory properties, LMWHs could be superior to DOACs. This finding may be of interest particularly in patients with extensive DVT at high risk of moderate to severe PTS, but needs to be confirmed by a dedicated RCT.

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“…This is particularly relevant as the treatment spectrum 38 as well as recurrence risk for isolated calf DVT is different from that for proximal DVT. 39,40 Additionally, the risk of developing moderate or severe PTS is lower in calf DVT than in proximal DVT, 41 although still clinically relevant.…”

Section: Imaging Techniquesmentioning

confidence: 99%

How to Differentiate Recurrent Deep Vein Thrombosis from Postthrombotic Syndrome

2020

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Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Accuracy of diagnosis is thus of vital importance. Failure to diagnose VTE increases the risk of progression and complications. Conversely, anticoagulation as a result of an incorrect diagnosis exposes patients to the associated hazards of bleeding. The diagnostic management of recurrent deep vein thrombosis (DVT) and postthrombotic syndrome (PTS) is especially challenging due to the lack of well-established diagnostic standards. Particularly, the differentiation between the two is notoriously difficult as symptoms, clinical signs, and diagnostic test findings largely overlap. This review highlights the current diagnostic and management strategies for recurrent DVT and PTS with a focus on clinical findings and imaging modalities. We also discuss current open questions for clinicians in the field, anticipating future directions and predictions for the year 2050.

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Long-term Risk of Postthrombotic Syndrome After Symptomatic Distal Deep Vein Thrombosis: The CACTUS-PTS Study

Cited by 9 publications

References 15 publications

Incidence and severity of postthrombotic syndrome after iliofemoral thrombosis – results of the Iliaca-PTS – Registry

Incidence and severity of postthrombotic syndrome after iliofemoral thrombosis – results of the Iliaca-PTS – Registry

Prevention of the Postthrombotic Syndrome with Anticoagulation: A Narrative Review

How to Differentiate Recurrent Deep Vein Thrombosis from Postthrombotic Syndrome

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