Predictors of the post‐thrombotic syndrome with non‐invasive venous examinations in patients 6 weeks after a first episode of deep vein thrombosis

Abstract

To cite this article: Tick LW, Doggen CJM, Rosendaal FR, Faber WR, Bousema MT, Mackaay AJC, van Balen P, Kramer MHH. Predictors of the post-thrombotic syndrome with non-invasive venous examinations in patients 6 weeks after a first episode of deep vein thrombosis. J Thromb Haemost 2010; 8: 2685-92.Summary. Background: Post-thrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) affecting a large number of patients. Because of its potential debilitating effects, identification of patients at high risk for the development of this syndrome is relevant, and only a few predictors are known. Objectives: To assess the incidence and potential predictors of PTS. Methods: We prospectively followed 111 consecutive patients for 2 years after a first episode of objectively documented DVT of the leg. With non-invasive venous examinations, residual thrombosis, valvular reflux, calf muscle pump function and venous outflow resistance were assessed at 6 weeks, 3 months, 6 months, 1 year, and 2 years. The Clinical, Etiologic, Anatomic, and Pathophysiologi classification was used to record the occurrence and severity of PTS. Regression analysis with area under the receiver operating characteristic (ROC) curve was performed to identify potential predictors. Results: The cumulative incidence of PTS was 46% after 3 months, and the incidence and severity did not increase further. Men appeared to be at increased risk as compared with women (risk ratio [RR] 1.4, 95% confidence interval [CI] 0.9-2.2), as were patients over 50 years as compared with younger patients (RR 1.4%, 95% CI 0.9-2

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

“…7,8,47,51,73,75 Residual thrombosis after treatment of DVT has also been shown to be a predictor of PTS. 27,28,62,76 In patients with a first episode of DVT, the risk of PTS was 1.6-fold higher (95% CI, 1.0-2.5) in those with residual proximal thrombosis compared with those without this finding. 62 A recent study by Comerota et al 76 documented a statistically significant correlation between residual thrombus after CDT and PTS severity.…”

“…A study by Tick et al 46 reported that DVT in the femoral and iliac veins was associated with an increased risk of PTS compared with popliteal vein thrombosis (RR, 1.3; 95% CI, 1.1-1.6), perhaps because of more rapid and complete resolution of thrombosis in distal vein segments. 62 In a study by Labropoulos et al 67 of patients with a first episode of acute DVT, PTS was more frequent and more severe when the iliac vein was occluded in conjunction with other veins. In the previously noted study of PTS after pregnancy-related DVT, the strongest predictor of PTS was proximal thrombosis that occurred postpartum (OR, 6.3; 95% CI, 2.0-19.8).…”

“…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. 8,10,46,62 Recent work on the risk of PTS after pregnancy-associated DVT reported that age >33 years at the time of index pregnancy is a predictor of PTS (odds ratio [OR], 3.9; 95% CI, 1.8-8.3), as is daily smoking (OR, 2.9; 95% CI, 1.3-6.4).…”

Innate Effector-Memory T-Cell Activation Regulates Post-Thrombotic Vein Wall Inflammation and Thrombus Resolution

“…39,40 Among known age-dependent changes in the immune system, the dynamic of the memory T-cell compartment seems particularly striking. After an initial marked increase in the first decade of life, memory T-cell frequencies reach a plateau and remain stable throughout the adulthood.…”

How I treat isolated distal deep vein thrombosis (IDDVT)

“…40 A recent prospective study showed that patients with proximal DVT had a relative risk of developing PTS of 2.3 (95% confidence interval [CI], 1.0-5.6) compared with patients with IDDVT, although the latter were not free from this late complication. 41 In conclusion, it should be recognized that, because of the scarcity of prospective, blind, nonintervention studies, both the natural history of IDDVT and its clinical relevance are still not clearly understood. In general, however, it can be said that the proximal extension of IDDVT, although at rates much lower than previously reported, is not rare, and the disease-with or without extension-is not always free from acute and late complications.…”