A portion of this study was presented at the American Society of Hematology Annual Meeting, 9–13 December 2011, San Diego, CA, USA.
Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency
Article first published online: 13 MAR 2013
© 2012 International Society on Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
Volume 11, Issue 3, pages 474–480, March 2013
How to Cite
Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency. J Thromb Haemost 2013; 11: 474–80., , , , , , , , , , , , , , , .
- Issue published online: 13 MAR 2013
- Article first published online: 13 MAR 2013
- Accepted manuscript online: 19 DEC 2012 11:11PM EST
- Manuscript Accepted: 7 DEC 2012
- Manuscript Received: 1 OCT 2012
- deep vein thrombosis;
- post-thrombotic syndrome;
- risk factors;
- venous insufficiency;
- venous thromboembolism;
- Villalta scale
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.
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).
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).
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.