Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency

Authors

  • J. P. Galanaud,

    1. Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
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  • C. A. Holcroft,

    1. Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
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  • M. A. Rodger,

    1. Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
    2. Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
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  • M. J. Kovacs,

    1. Division of Hematology, Department of Medicine, University of Western Ontario, London, Canada
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  • M. T. Betancourt,

    1. Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
    2. Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
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  • P. S. Wells,

    1. Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
    2. Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
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  • D. R. Anderson,

    1. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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  • I. Chagnon,

    1. Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
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  • G. Le Gal,

    1. Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
    2. Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
    3. Université de Brest, EA3878, Brest, France
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  • S. Solymoss,

    1. Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
    2. Department of Medicine, McGill University, Montreal, Quebec, Canada
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  • M. A. Crowther,

    1. Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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  • A. Perrier,

    1. Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
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  • R. H. White,

    1. Department of Medicine, UC Davis School of Medicine, Sacramento, California, USA
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  • L. M. Vickars,

    1. Department of Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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  • T. Ramsay,

    1. Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
    2. Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
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  • S. R. Kahn

    Corresponding author
    1. Department of Medicine, McGill University, Montreal, Quebec, Canada
    • Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
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  • A portion of this study was presented at the American Society of Hematology Annual Meeting, 9–13 December 2011, San Diego, CA, USA.

Correspondence: Susan R. Kahn, Division of Internal Medicine, Department of Medicine, McGill University, and Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Ste. Catherine, Rm. H-420.1, Montreal, Quebec, Canada, H3T 1E2.

Tel.: +1 514 340 7587; fax: +1 514 340 7564.

E-mail: susan.kahn@mcgill.ca

Summary

Background

Post-thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). Its diagnosis is based on clinical characteristics. However, symptoms and signs of PTS are non-specific, and could result from concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS.

Methods

Using data from the REVERSE multicenter study, we assessed risk factors for PTS in patients with a first unprovoked unilateral proximal DVT 5–7 months earlier who were free of clinically significant PVI (defined as absence of moderate or severe venous ectasia in the contralateral leg).

Results

Among the 328 patients considered, the prevalence of PTS was 27.1%. Obesity (odds ratio [OR] 2.6 [95% confidence interval (CI) 1.5–4.7]), mild contralateral venous ectasia (OR 2.2 [95% CI 1.1–4.3]), poor International Normalized Ratio (INR) control (OR per additional 1% of time with INR < 2 during anticoagulant treatment of 1.018 [95% CI 1.003–1.034]) and the presence of residual venous obstruction on ultrasound (OR 2.1 [95% CI 1.1–3.7]) significantly increased the risk for PTS in multivariable analyses. When we restricted our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n = 244), the prevalence of PTS decreased slightly to 24.6%. Only obesity remained an independent predictor of PTS (OR 2.6 [95% CI 1.3–5.0]). Poor INR control and residual venous obstruction also increased the risk, but the results were no longer statistically significant (OR 1.017 [95% CI 0.999–1.035] and OR 1.7 [95% CI 0.9–3.3], respectively).

Conclusions

After a first unprovoked proximal DVT, obese patients and patients with even mild PVI constitute a group at increased risk of developing PTS for whom particular attention should be paid with respect to PTS prevention. Careful monitoring of anticoagulant treatment may prevent PTS.

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