Relationship Between Deep Venous Thrombosis and the Postthrombotic Syndrome

Kahn, Susan R.; Ginsberg, Jeffrey S.

doi:10.1001/archinte.164.1.17

Cited by 350 publications

(268 citation statements)

References 99 publications

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“…The severity of PTS was scored according to both the clinical score (range 0-6) of the revised CEAP classification (Clinical, Etiologic, Anatomic, and Pathophysiologic) [8] and the Villalta score [3]. In the CEAP classification patients with class 0 represent no visible or palpable signs of venous disease symptoms of PTS; class 1 telangiectases, reticular veins or malleolar flare; class 2 varicose disease; class 3 oedema without skin changes; class 4 skin changes ascribed to venous disease (4a eczema and pigmentation, 4b lipodermatosclerosis and atrophy blanche); class 5 skin changes with a healed ulcer and class 6 skin changes with active ulceration.…”

Section: Methodsmentioning

confidence: 99%

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Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome

Roumen-Klappe

Heijer

Rossum

et al. 2008

J Thromb Thrombolysis

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Objective The purpose of this randomized study was to evaluate the influence of immediate multilayer compression bandages before application of elastic stockings in the acute phase of deep-vein thrombosis (DVT) on development of the post-thrombotic syndrome (PTS). Methods Sixty-nine patients with acute symptomatic DVT were randomized to immediate bandaging (n = 34) or no bandaging (n = 35). After reduction of edema sized-to-fit elastic stockings were applied in all patients after 7-14 days. Follow-up visits and non-invasive examinations were planned after 7, 30 and 90 days and 1 year. Venous outflow resistance (VOR) was measured by strain gauge plethysmography. Thrombosis score (TS) and reflux were measured by duplex scanning. After one year patients were evaluated for clinical PTS using both the clinical scale of the CEAP classification and the Villalta score. Results Improvement of clinical symptoms and decrease of leg circumference was better on day 7 in the bandaging group, but after 1 and 3 months clinical symptoms had improved equally in both groups. In 7 patients in the no-bandaging group a bandage was applied after all because of persistent edema after 10 days. There were no differences in VOR, TS and reflux. Using the CEAP classification the incidence of PTS was 39% in patients with bandages and 42% in patients without bandages (RR 0.91,. Using the Villalta score the incidence of PTS was resp. 29 and 33% (RR 0.87, 95% CI 0.41-1.8). There was no difference in severity of PTS. Conclusion Immediate multilayer compression bandaging in the acute phase of DVT is effective in reducing edema and complaints in the first week, but has no effect on thrombus regression, valve incompetence and the development of clinical PTS after 1 year.

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Section: Methodsmentioning

confidence: 99%

“…Although it was generally considered to take 5-10 years to develop PTS, the current opinion is that PTS already becomes clinically manifest within 1-2 years following the acute thrombotic event [1][2][3]. Impairment of quality of life is correlated with severity of PTS [4,5].…”

Section: Introductionmentioning

confidence: 99%

Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome

Roumen-Klappe

Heijer

Rossum

et al. 2008

J Thromb Thrombolysis

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“…Dysfunction of the valves of the deep venous system is most often a consequence of damage from previous deep vein thrombosis (DVT). 20 Dysfunction or incompetence of the valves in the superficial venous system also allows retrograde flow of blood and increased hydrostatic pressures. Valve failure may be primary the result of preexisting weakness in the vessel wall or valve leaflets, or secondary to direct injury, superficial phlebitis, or excessive venous distention resulting from hormonal effects or high pressure.…”

Section: Venous Pathophysiology and Dysfunctionmentioning

confidence: 99%

Chronic Venous Insufficiency

2005

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C hronic venous disease is often overlooked by primary and cardiovascular care providers because of an underappreciation of the magnitude and impact of the problem. The importance of chronic venous disease is related to the number of people with the disease and the socioeconomic impact of its more severe manifestations. Unfortunately, the literature concerning the prevalence and incidence of chronic venous disease has varied greatly because of differences in the methods of evaluation, criteria for definition, and the geographic regions analyzed. The most common manifestations of chronic venous disease are dilated cutaneous veins, such as telangiectases and reticular veins, and varicose veins. The term chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities with venous hypertension causing various pathologies including pain, swelling, edema, skin changes, and ulcerations. Although the term CVI is often used to exclude uncomplicated varicose veins, varicose veins have incompetent valves with increased venous pressure leading to progressive dilation and tortuosity. We will use the term CVI to represent the full spectrum of manifestations of chronic venous disease.Varicose veins have an estimated prevalence between 5% to 30% in the adult population, with a female to male predominance of 3 to 1, although a more recent study supports a higher male prevalence. 1 The Edinburgh Vein Study screened 1566 subjects with duplex ultrasound for reflux finding CVI in 9.4% of men and 6.6% of women, after age adjustment, which rose significantly with age (21.2% in men Ͼ50 years old, and 12.0% in women Ͼ50 years old). 2 The San Valentino Vascular Screening Project found among the 30 000 subjects evaluated by clinical assessment and duplex ultrasound a prevalence of 7% for varicose veins and 0.86% for "symptomatic" CVI. 3 As in previous studies, CVI was more common with increasing age, but there was no significant sex difference. The rate of varicose vein development may be estimated from the Framingham Heart Study, which found an annual incidence of 2.6% in women and 1.9% in men. 4 Risk factors found to be associated with CVI include age, sex, a family history of varicose veins, obesity, pregnancy, phlebitis, and previous leg injury. 5,6 There also may be environmental or behavioral factors associated with CVI such as prolonged standing and perhaps a sitting posture at work. 6,7 Varicose veins have a significant impact on healthcare resources, with millions of people seeking medical attention for their cosmetic appearance annually. Although often minimized, the cosmetic consequences may adversely affect an individual's quality of life and are associated with other manifestations.The more serious consequences of CVI such as venous ulcers have an estimated prevalence of Ϸ0.3%, although active or healed ulcers are seen in Ϸ1% of the adult population. 8 It has been estimated that Ϸ2.5 million people have CVI in the United States, and of those, Ϸ20% develop venous ulcers. 9 The ov...

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“…We chose this definition because calf DVT was also associated with a significant risk of subsequent post‐thrombotic syndrome 13. The venous USs were carried out by six laboratory technicians only during the daytime.…”

Section: Methodsmentioning

confidence: 99%

Better documentation in electronic medical records would lead to an increased use of lower extremity venous ultrasound in the inpatient setting: a retrospective study

Takechi

Dote

Kim

et al. 2017

Acute Medicine & Surgery

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AimWe hypothesized that the quality of the assessment of abnormal laboratory data in the emergency department (ED) could affect the hospital‐attending physicians’ decision‐making after a patient's hospitalization. To test this hypothesis, we investigated how patients with a positive D‐dimer result were reported by ED physicians in electronic medical records, and measured whether lower extremity venous ultrasonography examination was undertaken during hospitalization by the hospital‐attending physicians.MethodsIn an urban tertiary acute care general hospital in Japan, between January 2012 and December 2013, we included patients hospitalized after a positive D‐dimer measurement (≥1.0 μg/mL) that was taken in the emergency department. We retrospectively measured the quality of ED physician assessments. Then we examined whether that affected the decisions of attending physicians to order lower extremity venous ultrasonography examinations during hospitalization. The exposure variable was the quality of the ED physicians’ assessment of patients with positive D‐dimer results. The outcome was whether a lower extremity venous ultrasonography examination was ordered by the attending physician during hospitalization.ResultsWhen assessments were described by ED physicians for patients with positive D‐dimer results, the attending physicians frequently ordered lower extremity venous ultrasonography (odds ratio, 10.74; 95% confidence interval, 5.92–19.50), even if the assessments only contained “copied and pasted” laboratory data (odds ratio, 1.68; 95% confidence interval, 2.10–2.40).ConclusionsBetter documentation by ED physicians, regarding patients with positive D‐dimer results, strongly affected the decisions made by attending physicians to order lower extremity venous ultrasonography examination.

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Relationship Between Deep Venous Thrombosis and the Postthrombotic Syndrome

Cited by 350 publications

References 99 publications

Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome

Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome

Chronic Venous Insufficiency

Better documentation in electronic medical records would lead to an increased use of lower extremity venous ultrasound in the inpatient setting: a retrospective study

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