Predictors of long-term post-thrombotic syndrome following high proximal deep vein thrombosis: a cross-sectional study

Abstract Background Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT. Methods During 2006–09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (> 1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression. Results Eighty-eight patients (52%) were included 8–10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93–0.99), and 1.23 (95% CI, 1.02–1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments. Conclusions In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.

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Predictors of long-term post-thrombotic syndrome following high proximal deep vein thrombosis: a cross-sectional study

10.21203/rs.3.rs-29584/v1 ◽

2020 ◽

Author(s):

Marit Engeseth ◽

Tone Enden ◽

Per Morten Sandset ◽

Hilde Skuterud Wik

Keyword(s):

Deep Vein Thrombosis ◽

Proximal Deep Vein Thrombosis ◽

Cross Sectional ◽

Clinical Criteria ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Younger Age ◽

Deep Vein

Abstract Background Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT. Methods During 2006-09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (>1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression. Results 88 patients (52%) were included 8-10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93-0.99), and 1.23 (95% CI, 1.02-1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments.Conclusions In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.

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Predictors of long-term post-thrombotic syndrome following high proximal deep vein thrombosis: a cross-sectional study

10.21203/rs.3.rs-29584/v2 ◽

2020 ◽

Author(s):

Marit Engeseth ◽

Tone Enden ◽

Per Morten Sandset ◽

Hilde Skuterud Wik

Keyword(s):

Deep Vein Thrombosis ◽

Proximal Deep Vein Thrombosis ◽

Cross Sectional ◽

Clinical Criteria ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Younger Age ◽

Deep Vein

Abstract Background Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT.Methods During 2006-09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (>1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression. Results 88 patients (52%) were included 8-10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93-0.99), and 1.23 (95% CI, 1.02-1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments.Conclusions In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.

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Predictors of long-term post-thrombotic syndrome following high proximal deep vein thrombosis: a cross-sectional study

10.21203/rs.3.rs-29584/v3 ◽

2020 ◽

Author(s):

Marit Engeseth ◽

Tone Enden ◽

Per Morten Sandset ◽

Hilde Skuterud Wik

Keyword(s):

Deep Vein Thrombosis ◽

Proximal Deep Vein Thrombosis ◽

Cross Sectional ◽

Clinical Criteria ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Younger Age ◽

Deep Vein

Abstract Background Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT. Methods During 2006-09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (>1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression. Results 88 patients (52%) were included 8-10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93-0.99), and 1.23 (95% CI, 1.02-1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments.Conclusions In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.

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Concomitant Use of Diosmin/Hesperidin and Oral Rivaroxaban Increases Deep Vein Recanalization and Reduces the Incidence of Post-Thrombotic Syndrome in Patients with Proximal Deep Vein Thrombosis

Blood ◽

10.1182/blood-2018-99-110084 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 986-986

Author(s):

Kirill Lobastov ◽

Iliya Schastlivtsev ◽

Victor Barinov

Keyword(s):

Deep Vein Thrombosis ◽

Clinical Severity ◽

Proximal Deep Vein Thrombosis ◽

Control Groups ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

And Control ◽

Deep Vein ◽

The Impact

Abstract Aim: To assess the impact of long-term Diosmin/Hesperidin use in the treatment of proximal deep vein thrombosis (DVT). Methods: This study was a pilot randomized open-label study with blinded outcome assessor - enrolled patients with their first episodes of popliteal-femoral DVT confirmed by duplex ultrasound (DUS). All participants were randomized into two groups: 1.) control that received a standard treatment with oral Rivaroxaban, and 2.) experimental that required additional treatment with Diosmin/Hesperidin 450/50 mg twice a day. Both drugs were used for six months. Patients were followed-up for the whole treatment period with series DUS every two months in order to evaluate the degree of recanalization by popliteal (PV), superficial femoral (SFV), and common femoral (CFV) veins' compressibility. Thrombi extension was assessed by modified Marder score. At the end of the follow-up period, patients were assessed with Villalta and venous clinical severity scores. Post-thrombotic syndrome (PTS) was diagnosed in those who had ≥5 Villalta score. Results: Sixty patients were randomized to the control and experimental groups (n=30 in each group). There were 40 men and 20 women with mean age of 56.3±13.4. Clinically unprovoked DVT was recognized in 65% of cases and left side localization in 45%. The median of Marder baseline scores were 15.0±4.8 and 11.1±4.3 in the experimental and control groups, respectively (p=0.002). After six months of treatment, the Marder score decreased to 0.8±1.6 and 2.8±3.5 in the main control groups, respectively (p=0.006). The generalized linear model repeated measures found a greater reduction in the Marder score (р <0.0001) and increased speed of recanalization on SFV (р <0.0001) with a non-significant tendency in the CFV (p=0.130) and PV (p=0.204) in the experimental group compared to the control one. Full recanalization of the PV at six months was observed in 24 patients (80%), who had received Diosmin/Hesperidin, and only in 17 persons (57%) of the control group (p=0.047). The median of Villalta score in the group treated with Diosmin/Hesperidin was significantly lower compared to the control one (2.9±2.7 versus 5.8±3.0 [p <0.0001]). The same difference was found for VCSS score (2.3±1.9 versus 4.9±1.9 [p <0001]). According to the Villalta score, PTS was recognized in six patients (20%) and 17 patients (57%) in the experimental and control groups, respectively (p=0.004). Conclusion: Long-term treatment with Diosmin/Hesperidin can increase the speed of deep vein recanalization and reduce the incidence of PTS diagnosed at six months in patients with proximal DVT treated with oral rivaroxaban. Disclosures Lobastov: Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Schastlivtsev:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Barinov:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau.

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Measurements of Calf Muscle Oxygenation During Standing and Exercise in the Long-Term Follow-up of the First Episode of Proximal Deep Vein Thrombosis

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2013.10.023 ◽

2014 ◽

Vol 2 (1) ◽

pp. 110-111

Author(s):

T. Yamaki ◽

H. Konoeda ◽

A. Osada ◽

H. Sakurai

Keyword(s):

Deep Vein Thrombosis ◽

Calf Muscle ◽

Muscle Oxygenation ◽

Proximal Deep Vein Thrombosis ◽

First Episode ◽

Vein Thrombosis ◽

Long Term Follow Up ◽

Deep Vein

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Long-term follow-up of patients with suspected deep vein thrombosis of the upper extremity: survival, risk factors and post-thrombotic syndrome

European Journal of Internal Medicine ◽

10.1016/j.ejim.2004.07.012 ◽

2004 ◽

Vol 15 (8) ◽

pp. 503-507 ◽

Cited By ~ 22

Author(s):

Henk J. Baarslag ◽

Maria M.W. Koopman ◽

Barbara A. Hutten ◽

May W. Linthorst Homan ◽

Harry R. Büller ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Upper Extremity ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Long Term Follow Up ◽

Survival Risk ◽

Deep Vein

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The efficacy of rotational pharmaco-mechanical thrombectomy in patients with acute iliofemoral deep vein thrombosis: Is the standard treatment of deep vein thrombosis changing?

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520966880 ◽

2020 ◽

pp. 026835552096688

Author(s):

Orhan Rodoplu ◽

Cenk Eray Yildiz ◽

Didem Melis Oztas ◽

Metin Onur Beyaz ◽

Mustafa Ozer Ulukan ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Mechanical Thrombolysis ◽

Multicenter Studies ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Long Term Follow Up ◽

Thrombectomy Device ◽

Deep Vein

Objective In this study, we aimed to evaluate the efficiency of rotational thrombectomy device in pharmaco-mechanical thrombolysis for symptomatic acute ilio-femoral deep vein thrombosis. Materials and methods Between August 2013 and May 2018,82 patients with acute deep vein thrombosis comprising the iliofemoral segment whom underwent Pharmaco-mechanical thrombolysis were evaluated retrospectively. The Cleaner thrombectomy device was used. The resolution of thrombi was examined and graded. Development of post-thrombotic syndrome was assessed with Villalta scores. Results 75 patients (91.4%) had complete thrombus resolution. Between 50–99% resolution was noted in 6 patients (7.4%) and in one (1.2%) case less than %50 thrombus resolution was obtained. Seventy-five patients (91%) of the cohort could be treated in a single session; 7 patients (8.6%) required reintervention(s). Although improved post-thrombotic syndrome rates were lower at the short term, Villalta scores gradually increased during follow up. Conclusions In conclusion, Pharmaco-mechanical thrombolysis with Cleaner thrombectomy device is a safe and beneficial method for the treatment of acute iliofemoral deep vein thrombosis. Long term follow up data of large volume multicenter studies are warranted.

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Post-thrombotic syndrome – a position paper from European Society of Vascular Medicine

VASA ◽

10.1024/0301-1526/a000946 ◽

2021 ◽

pp. 1-10

Author(s):

Adriana Visonà ◽

Isabelle Quere ◽

Lucia Mazzolai ◽

Maria Amitrano ◽

Marzia Lugli ◽

...

Keyword(s):

Adverse Event ◽

Deep Vein Thrombosis ◽

Venous Insufficiency ◽

Position Paper ◽

Vascular Medicine ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Deep Vein

Summary: Post-thrombotic syndrome (PTS) is a chronic venous insufficiency manifestation following an episode of deep-vein thrombosis (DVT). It is an important and frequent long-term adverse event of proximal DVT affecting 20–50% of patients. This position paper integrates data guiding clinicians in deciding PTS diagnosis, treatment and follow-up.

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