The post-thrombotic syndrome: incidence and prognostic value of non-invasive venous examinations in a six-year follow-up study

Roumen-Klappe, Edith M.; Heijer, Martin den; Janssen, Mirian C. H.; Vleuten, Carine van der; Thien, Theo; Wollersheim, Hub

doi:10.1160/th05-03-0146

Cited by 112 publications

(112 citation statements)

References 26 publications

(23 reference statements)

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“…Previously we demonstrated that the measurement of TS, VOR and reflux at three months follow-up can be used as a proxy or surrogate endpoint for PTS [2]. In the current study there was no difference in the decline of VOR en TS between both groups.…”

Section: Discussionsupporting

confidence: 45%

“…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%

“…The pathogenesis of PTS is not completely understood, but it is suggested that persistent obstruction and the development of valvular insufficiency after DVT leads to venous hypertension, resulting in symptoms like pain and swelling of the leg and signs like edema, hyperpigmentation and the occurrence of venous ulcers. In a previous study it was shown that the combination of an elevated venous resistance, thrombosis score and reflux 3 months after DVT could predict PTS with reasonable accuracy [2]. For this reason preventing valve damage and reducing venous hypertension are likely to be important in preventing PTS already early in the treatment of DVT.…”

Section: Introductionmentioning

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: Discussionsupporting

confidence: 45%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…A Dutch study 21 conducted in 2004 prospectively evaluated the incidence and severity of PTS in 93 DVT patients under careful clinical surveillance using the CEAP classification ( Figure 2). This study confirmed the findings from previous studies, whereby only half of DVT patients had no clear evidence of PTS (CEAP 0/1 and CEAP 2; Figure 2).…”

Section: Clinical Features Of Ptsmentioning

confidence: 99%

Diagnosis and treatment of DVT and prevention of DVT recurrence and the PTS: bridging the gap between DVT and PTS in the primary care setting or outpatient ward

Michiels¹,

Moosdorff²,

Lao³

et al. 2017

JVD

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Duplex ultrasonography (DUS) does pick up alternative diagnoses (AD) includingBaker's cyst, muscle hematomas, old deep vein thrombosis (DVT), and superficial vein thrombosis. The sequential use of DUS followed by a sensitive D-dimer test and a clinical score assessment is a safe and effective noninvasive strategy to exclude and diagnose DVT and AD in patients with suspected DVT. DVT patients are recommended to wear medical elastic stockings (MECS) for symptomatic relief of swollen legs during the acute phase of DVT, or when postthrombotic syndrome (PTS) is present. In routine daily practice, discontinuation of anticoagulation at 6 months post-DVT is followed by a subsequent 20%-30% DVT recurrence rate; this is the main cause of PTS after 1-5 years of follow-up. To bridge the gap between DVT and PTS, the frequent occurrence of PTS is best prevented by prolonged anticoagulation, if indicated, based on objective risk factors for DVT recurrence. Post-DVT rapid and complete recanalization on DUS within 1-3 months and no reflux is associated with no development of PTS, obviating the need of MECS; furthermore, anticoagulation can be discontinued after 3-6 months post-DVT. Absence of residual venous thrombosis (complete recanalization) at 3 months post-DVT with no reflux and with a low PTS score is associated with no recurrence of DVT (1.2% of 100 patient/years). The presence of reflux due to valve destruction, irrespective of the degree of recanalization on DUS at 3-6 months post-DVT, is associated with a high risk of DVT recurrence and symptomatic PTS, indicating the need to wear MECS and extend anticoagulation. Appearance of reflux on DUS at 6 months or 9 months post-DVT in symptomatic PTS patients is associated with increased DVT recurrence in about one-third of post-DVT patients after the discontinuation of anticoagulation. We designed a prospective safety outcome management study to bridge the gap between DVT and PTS, with the aim of reducing the overall DVT recurrence rate to ,3% patient/years during long-term follow-up.

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“…Acute iliofemoral deep vein thrombosis (DVT) is a major cause for morbidity, as approximately half of the patients managed conservatively with anticoagulation therapy and compression stockings develop the post-thrombotic syndrome (PTS) [1][2][3][4]. The residual thrombus load correlates with the probability of a future PTS [5,6].…”

Section: Introductionmentioning

confidence: 99%

Early clinical outcomes of a novel rheolytic directional thrombectomy technique for patients with iliofemoral deep vein thrombosis

Dopheide

Sebastian

Engelberger

et al. 2018

Vasa

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Summary:Background: Rheolytic thrombectomy (RT) for acute iliofemoral deep vein thrombosis (DVT) with fi rst-generation techniques is often incomplete and adjunctive conventional catheter-directed thrombolysis (CDT) is required in more than half of patients to achieve venous patency. Patients and methods: From the prospective Bern Venous Stent Registry, we investigated rates of primary treatment success, primary patency, and post-thrombotic syndrome (PTS) from 40 consecutive patients (mean age 51 ± 19 years, 45 % women) with acute iliofemoral DVT, treated with a novel directional RT technology and stent placement. Overall, 24 patients were treated for native-vessel iliofemoral DVT (11 with single-session RT, 13 with bailout RT after failed CDT) and 16 for iliofemoral stent thrombosis. Pulse-spray thrombolysis (r-tPA 10 mg) was performed in 29 (73 %) patients. The mean follow-up duration was 193 ± 132 days (minimum 90 days). Results: Overall, primary treatment success of RT was 95 %; only two patients required adjunctive CDT to restore patency. In 24 patients with native-vessel DVT, six-month primary patency was 92 % (95 %CI 75-99 %), and 23 patients (96 %) were free from the PTS according to the Villalta score. In 16 patients with stent thrombosis, six-month primary patency was 63 % (95 %CI 35-85 %) and 50 % were free from PTS. Except for transient macroscopic haemoglobinuria in all patients, no other side effects were recorded. Conclusions: In patients with iliofemoral DVT of native or stented vessels, RT followed by stent placement appears to be effective and safe. The novel technique enables single-session DVT treatment in the majority of patients without the need for prolonged CDT.

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The post-thrombotic syndrome: incidence and prognostic value of non-invasive venous examinations in a six-year follow-up study

Cited by 112 publications

References 26 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

Diagnosis and treatment of DVT and prevention of DVT recurrence and the PTS: bridging the gap between DVT and PTS in the primary care setting or outpatient ward

Early clinical outcomes of a novel rheolytic directional thrombectomy technique for patients with iliofemoral deep vein thrombosis

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