Prospective Study of Natural History of Deep Vein Thrombosis: Early Predictors of Poor Late Outcomes

Rij, André M. van; Hill, Gerry B.; Krysa, Jo; Dutton, Samantha; Dickson, Riordon; Christie, Ross; Smillie, Judi; Jiang, Ping; Solomon, C.

doi:10.1016/j.avsg.2012.09.018

Cited by 32 publications

(17 citation statements)

References 19 publications

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“…Em diversos estudos publicados a presença de TVP envolvendo as veias ilíacas e a veia femoral comum é um fator independente para o desenvolvimento de síndrome pós--trombótica 3,14,15 .…”

Section: Discussionunclassified

Síndrome pós‐trombótica e qualidade de vida em doentes com trombose venosa ilio‐femoral

Maia

Cruz

Vidoedo

et al. 2014

Angiologia e Cirurgia Vascular

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Recebido a 4 de julho de 2014; aceite a 10 de setembro de 2014 Disponível na Internet a 23 de outubro de 2014 PALAVRAS-CHAVETrombose venosa ilio-femoral; Trombólise dirigida por cateter; Qualidade de vida Resumo Objetivo: Caraterizar o síndrome pós-trombótico e a qualidade de vida em doentes com antecedentes de trombose venosa profunda (TVP) ilio-femoral, possíveis candidatos a trombólise dirigida por cateter na altura do diagnóstico. Material e métodos: Revisão retrospetiva dos processos clínicos dos doentes com o diagnóstico de TVP ilio-femoral de 1 de janeiro de 2009 a 31 de dezembro de 2013. Seleção dos doentes de acordo com os critérios consensualmente aceites para trombólise dirigida por cateter na altura do diagnóstico. Entrevista clínica, realização de eco-Doppler venoso dos membros inferiores com preenchimento da escala Villalta e dos questionários SF-36 e VEINES-QOL/Sym. Resultados: Durante este período foram observados, no Centro Hospitalar do Tâmega e Sousa, 369 doentes com TVP dos membros inferiores. Destas, 39 envolviam o sector ilio-femoral em doentes potencialmente candidatos a trombólise dirigida por cateter. Compareceram à convocatória 28 doentes, sendo 85,7% do sexo feminino. Sessenta e quatro por cento dos doentes usava regularmente meia elástica de contenção. Quarenta por cento dos doentes apresentavam um fator de trombofilia. Mais de 80% evidenciava alterações ao eco-Doppler, sendo que 46% mantinha oclusão venosa e 36% refluxo ilio-femoral. Do total dos doentes avaliados, 21% apresentava insuficiência femoro-poplítea. Cerca de 90% dos doentes evidenciava síndrome pós-trombótica, sendo grave em 18%. A qualidade de vida global, representada pelo estado geral de saúde, foi classificada como má em 43% dos doentes. A vitalidade e a saúde mental foram os domínios mais negativamente influenciados. Na análise estatística, os doentes com piores pontuações nos questionários de qualidade de vida foram os com síndrome pós-trombótica, as mulheres, os doentes com trombose no membro inferior direito, com refluxo ≥ 2 segundos, com insuficiência distal ao segmento envolvido pela TVP e quando a mesma foi diagnosticada no primeiro mês após um procedimento cirúrgico. Conclusão: Neste estudo verificamos uma elevada frequência de síndrome pós-trombótica e a uma diminuição significativa da qualidade de vida. Um subgrupo de doentes apresentou resultados particularmente preocupantes. Estes resultados sugerem que deverá ser considerado um ଝ Apresentado no XIV Congresso Nacional da Sociedade Portuguesa de Angiologia e Cirurgia Vascular, Braga 2014, como comunicação oral. * Autor para correspondência. Correio eletrónico: miguelopmm@hotmail.com (M. Maia).

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Section: Discussionunclassified

Síndrome pós‐trombótica e qualidade de vida em doentes com trombose venosa ilio‐femoral

Maia

Cruz

Vidoedo

et al. 2014

Angiologia e Cirurgia Vascular

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“…The proportion of patients with RVO was reported to be similar in patients with CEAP scores of C0-3 and C4-6 [56]. Finally, in a study of 114 patients followed by ultrasound and air plethysmography, four factors were identified as best predictors of PTS: extensive clot load on presentation; < 50% clot regression at 6 months; venous filling index of > 2.5 mL s À1 ; and abnormal outflow rate (< 0.6) [57]. The sonographic and biochemical properties of the initial or residual clot may prove to have a future role in predicting PTS, as several preliminary studies have attempted to characterize a sonographic and biochemical thrombus pattern that is most associated with PTS development [58][59][60].…”

Section: Risk Factorsmentioning

confidence: 91%

The postthrombotic syndrome: current evidence and future challenges

Rabinovich

Kahn

2017

Journal of Thrombosis and Haemostasis

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Postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients. PTS manifests as a spectrum of symptoms and signs of chronic venous insufficiency that can impose significant morbidity and have a negative impact on quality of life. Chronic venous hypertension caused by a combination of residual venous obstruction and valvular reflux is believed to play a major role in the pathophysiology of PTS. The Villalta scale is the most widely applied clinical scale used to diagnose and define PTS. Proximal DVT and recurrent ipsilateral DVT are the two principal established risk factors for PTS, and efforts in recent years have been focused on identifying a combination of clinical and biomarker predictors that will define high-risk patients and possibly new therapeutic targets. The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. Recent years have brought progress in our understanding of the role of endovascular techniques in the prevention and treatment of PTS and the subgroups of patients that may benefit from these modalities. Pharmacomechanical catheter-directed thrombolysis is the most promising interventional modality for prevention of PTS. This review summarizes the current state of evidence on PTS of the lower limbs, and highlights areas where uncertainty still exists that require further research.

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“…The thrombus load score is adapted from the updated reporting standards in venous disease from the Ad Hoc Committee on Reporting Standards of the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery [ 8 ] and a modified version of Haenan’s clot score as used by van Rij et al [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

Deep vein thrombosis resolution, recurrence and post-thrombotic syndrome: a prospective observational study protocol

2016

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BackgroundReasons for the variation in response of deep vein thrombosis (DVT) to anticoagulation treatment are not known. Some patients develop complications such as post-thrombotic syndrome or recurrent DVT but others make a full recovery. The aim of the study is to identify the level of variation in response to anticoagulation treatment and provide more precise and quantitative disease characterisation in response to treatment.MethodsA prospective observational study using duplex ultrasound to examine changes in thrombus characterisation, evolution and resolution over a 2 year period in patients with a confirmed DVT. Logistic regression analysis will be used to seek associations between characteristics present at baseline and the outcomes of DVT resolution, recurrence and the development of post-thrombotic syndrome (PTS).DiscussionThis research into the response to treatment of lower limb DVT and predictive factors for DVT resolution, recurrence and PTS could inform a more tailored approach to anticoagulation therapy for the future management of DVT.UKCRN ID: 16016. Registered on 20 January 2014.

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Prospective Study of Natural History of Deep Vein Thrombosis: Early Predictors of Poor Late Outcomes

Cited by 32 publications

References 19 publications

Síndrome pós‐trombótica e qualidade de vida em doentes com trombose venosa ilio‐femoral

Síndrome pós‐trombótica e qualidade de vida em doentes com trombose venosa ilio‐femoral

The postthrombotic syndrome: current evidence and future challenges

Deep vein thrombosis resolution, recurrence and post-thrombotic syndrome: a prospective observational study protocol

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