Severe postthrombotic syndrome is associated with characteristic sonographic pattern of the residual thrombosis

Abstract

Postthrombotic syndrome (PTS) may affect 50% of patients with deep venous thrombosis, 5-10% of them may present severe manifestations. The causes for PTS development and severity have not been well established. This study evaluated whether PTS may be associated with the presence, and echogenicity, of the residual vein thrombosis (RVT). We included patients with a history of deep venous thrombosis in the past 58 months. These patients were further evaluated for PTS diagnosis, clinical comorbidities, plasma levels of D-dimer, serum levels of C-reactive protein and for the presence of RVT. Particularly, RVT was detected by ultrasound examination and the residual thrombi echogenicity was determined by grayscale median (GSM). Fifty-six patients were included, of which 41 presented PTS. Mild PTS was detected in 23 patients, moderate PTS in 11 and severe PTS in seven patients. Patients with severe PTS showed higher body mass index, higher abdominal circumference and higher C-reactive protein levels when compared with the other patients (P = 0.007, P = 0.002, P = 0.02, respectively). The ultrasound-generated GSM was significantly lower in patients with severe PTS compared with patients with mild-moderate PTS or no PTS (median = 24, 35 and 41, respectively; P = 0.04). A GSM value less than 25, which was consistent with a hypoechoic RVT, was the best cut-off value to discriminate patients with severe PTS from those with mild or moderate PTS and those without PTS. RVT is a common finding among patients with PTS and the echogenicity of the RVT may impact the severity of PTS.

Residual Vein Thrombosis Echogenicity Is Associated to the Risk of DVT Recurrence: A Cohort Study

“…The method used in the present study has been adapted from arterial evaluation, as previously described. [15][16][17] In our study, a region assumed to be blood was selected, and the GSM defined as zero (minimum value). A region of the vein wall was selected, and its GSM defined as the value 200 (maximum value).…”

“…Exclusion criteria have been described in a previous study with this population. 16 During the period of the study, 385 patients with a history of DVT were attended at the clinic; however, 329 patients did not participate in the study due to the exclusion criteria or due to refusal to participate. Reasons for exclusion were venous thrombosis of other sites (n = 109), younger than 18 years or older than 80 years (n = 44), carriers of natural anticoagulant deficiency (n = 7), antiphospholipid syndrome or systemic autoimmune diseases (n = 25), cancer (n = 42), infection (n = 7), liver failure (n = 11), renal failure (n = 10), anticoagulant therapy (n = 64), and refusal to participate (n = 10).…”

“…The method used in the present study has been adapted from arterial evaluation, as previously described. 15 –17…”

The postthrombotic syndrome: current evidence and future challenges

“…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 .…”

“…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].…”