Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency

Abstract

Summary. Background: Post-thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). Its diagnosis is based on clinical characteristics. However, symptoms and signs of PTS are non-specific, and could result from concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS. Methods: Using data from the REVERSE multicenter study, we assessed risk factors for PTS in patients with a first unprovoked unilateral proximal DVT 5-7 months earlier who were free of clinically significant PVI (defined as absence of moderate or severe venous ectasia in the contralateral leg When we restricted our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n = 244), the prevalence of PTS decreased slightly to 24.6%. Only obesity remained an independent predictor of PTS (OR 2.6 [95% CI 1.3-5.0]). Poor INR control and residual venous obstruction also increased the risk, but the results were no longer statistically significant (OR 1.017 [95% CI 0.999-1.035] and OR 1.7 [95% CI 0.9-3.3], respectively). Conclusions: After a first unprovoked proximal DVT, obese patients and patients with even mild PVI constitute a group at increased risk of developing PTS for whom particular attention should be paid with respect to PTS prevention. Careful monitoring of anticoagulant treatment may prevent PTS.

The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies

“…27,44 A potential shortcoming of the Villalta scale (which also applies to other scales discussed below) is its relative nonspecificity; symptoms and signs could be due, at least in part, to nonvenous conditions or primary venous insufficiency. 45 In addition, although the presence of ulcer is noted, ulcer size and number are not. Nonetheless, the Villalta scale has been widely and successfully used to diagnose PTS, 21,35,46,47 to classify its severity, and to evaluate treatment, [48][49][50] including in randomized, controlled trials (RCTs).…”

“…8,10,[45][46][47]63 Older age also increases the risk of PTS. 8,11,46,47 There is no consistent association between sex and PTS; an almost equal number of studies have shown men or women to be at higher risk for PTS.…”

“…10,12,44,46,51,56,72,81 In some studies, asymptomatic DVT (eg, detected by systematic imaging in the course of a clinical trial) was associated with subsequent development of PTS, 70 whereas in others it was not. 71,72 Finally, inherited or acquired thrombophilia has generally not been shown to increase the risk of developing PTS, 10,45,46,51,81 although 1 study showed a protective effect. 63 In summary, key risk factors for PTS include older age, higher body mass index, recurrent ipsilateral DVT, more extensive DVT, greater symptom severity at 1 month, and subtherapeutic anticoagulation, especially in the first few months after DVT.…”

Postthrombotic syndrome and other outcomes of lower extremity deep vein thrombosis in children

“…Lack of DVT resolution was associated with PTS in children with LE-DVT in 1 previously reported pediatric study, and residual thrombosis is a known predictor of LE-PTS in adult patients. 15,[23][24][25][26] In addition, we found an interaction between sex and DVT trigger: (1) male sex was associated with a higher risk of PTS as compared with the female sex in the LR group, but this was not the case in the Non-LR group; and (2) Non-LR DVT were associated with a larger increase in risk of PTS as compared with LR-DVT among females, but this was not the case among males. The research on the association between sex and PTS in adult patients has yielded inconsistent results, and remains unclear.…”

“…c Secondary outcomes: LE-DVT resolution, recurrent LE-DVT, PE, and LE-DVT-related death were the secondary outcomes of the study. LE-DVT resolution referred to the radiologic resolution documented at the end of therapy, and was classified as complete, partial (wall thickening or worse), 15 no resolution, or extension. 16 For patients undergoing thrombolysis, "end of therapy" referred to the time immediately after this procedure (ie, end of thrombolysis).…”