post thrombotic syndrome
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Author(s):  
Sara Ng ◽  
Marc A. Rodger ◽  
Waleed Ghanima ◽  
Michael J Kovacs ◽  
Sudeep Shivakumar ◽  
...  

Angiology ◽  
2022 ◽  
pp. 000331972110708
Author(s):  
Luca Spiezia ◽  
Elena Campello ◽  
Chiara Simion ◽  
Anna Poretto ◽  
Fabio Dalla Valle ◽  
...  

The incidence of post-thrombotic syndrome (PTS) in patients with deep vein thrombosis (DVT) treated with direct oral anticoagulants (DOACs) remains a matter of debate. Hence, our endeavor to investigate a large cohort of patients with a first episode of proximal DVT treated with DOACs to ascertain the incidence and predisposing risk factors for PTS. All consecutive patients referred to the Thrombotic and Haemorrhagic Diseases Unit of Padova University Hospital (Italy) between January 2014 and January 2018 for a first episode of proximal DVT were considered for enrollment. Participants received DOACs for a minimum period of 3 months. PTS was assessed using the Villalta score up to 36 months after DVT diagnosis. Among 769 enrolled patients (M/F 353/416, age range 26–87 years), 152 (19.8%) developed PTS and 30 (3.9%) developed severe PTS. The adjusted hazard ratio was significant for obesity (1.64, 95% CI 1.28–2.39) and DVT site (femoral and/or iliac veins vs popliteal vein) (1.23, 95% CI 1.15–3.00). The incidence of PTS is not negligible in patients with proximal DVT despite the use of DOACs. We identified obesity and iliofemoral DVT as possible risk factors for PTS. Larger prospective studies are needed to confirm our findings and optimize therapeutic strategies.


Author(s):  
Ilia Makedonov ◽  
Susan R Kahn ◽  
Jameel Abdulrehman ◽  
Sam Schulman ◽  
Aurélien Delluc ◽  
...  

The post thrombotic syndrome (PTS) is chronic venous insufficiency secondary to a prior deep vein thrombosis (DVT). It is the most common complication of VTE and, while not fatal, it can lead to chronic, unremitting symptoms as well as societal and economic consequences. The cornerstone of PTS treatment lies in its prevention after DVT. Specific PTS preventative measures include the use of elastic compression stockings (ECS) and pharmacomechanical catheter directed thrombolysis (PCDT). However, the efficacy of these treatments has been questioned by large RCTs. So far, anticoagulation, primarily prescribed to prevent DVT extension and recurrence, appears to be the only unquestionably effective treatment for the prevention of PTS. In this literature review we present pathophysiological, biological, radiological and clinical data supporting the efficacy of anticoagulants to prevent PTS and the possible differential efficacy among available classes of anticoagulants (vitamin K antagonists (VKA), low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs)). Data suggest that LMWHs and DOACs are superior to VKAs, but no head-to-head comparison is available between DOACs and LMWHs. Owing to their potentially greater anti-inflammatory properties, LMWHs could be superior to DOACs. This finding may be of interest particularly in patients with extensive DVT at high risk of moderate to severe PTS, but needs to be confirmed by a dedicated RCT.


Author(s):  
Fergal O'Shaugnessy ◽  
Shravya Govindappagari ◽  
Yongmei Huang ◽  
Sbaa K. Syeda ◽  
Mary E. D'Alton ◽  
...  

Objective While the majority of venous thromboembolism (VTE) during pregnancy events resolve with anticoagulation, long-term complications may occur including (1) post-thrombotic syndrome and (2) chronic pulmonary embolism. The objective of this study was to determine risk of these two complications. Study Design A retrospective cohort study using the MarketScan databases was performed on deliveries from 2008 to 2014. We identified women aged 15 to 54 years diagnosed with acute VTE during pregnancy, the delivery hospitalization, or ≤60 days postpartum who received at least one prescription postpartum for anticoagulants. Risks of (1) chronic PE and (2) post-thrombotic syndrome were evaluated for women at 6, 12, 24, and 60 months after delivery hospitalization through 2017 via the International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes. Results Of 4,267 of 4,128,900 pregnancies complicated by VTE, the majority had DVT alone (61.8%, n = 2,637), while 25.8% had PE alone (n = 1,103) and 12.4% (n = 527) had both DVT and PE. Of the entire cohort, 3,328 retained insurance coverage at 6 months, 2,823 at 12 months, 2,161 at 24 months, and 831 at 60 months. Restricted to DVT, risk of post-thrombotic syndrome was 0.7% at 6 months (n = 17), 1.1% at 12 months (n = 22), 1.7% at 24 months (n = 26), and 2.7% at 60 months (n = 16). Among women with PE diagnoses, the risk of chronic PE was 2.4% at 6 months (n = 30), 3.3% at 12 months (n = 36), 4.2% at 24 months (n = 36), and 7.2% at 60 months (n = 24). Discussion In comparison to the general population, the risk of post-thrombotic syndrome was lower. In comparison, the risk of chronic PE was similar to the estimates in the general population at comparable time points after PE events. For women with obstetric PE, it may be appropriate to be vigilant for findings and symptoms associated with chronic PE. Key Points


2021 ◽  
Vol 207 ◽  
pp. 10-15
Author(s):  
Luigi Di Pino ◽  
Bruno Francaviglia ◽  
Marco Frazzetto ◽  
Noemi Valenti ◽  
Piera Capranzano

Haematologica ◽  
2021 ◽  
Author(s):  
Paolo Prandoni ◽  
Anthonie WA Lensing ◽  
Martin H Prins ◽  
Sabina Villalta ◽  
Raffaele Pesavento ◽  
...  

Not available.


Author(s):  
Laura Avila ◽  
Nour Amiri ◽  
Riddhita De ◽  
Jennifer Vincelli ◽  
Eleanor M Pullenayegum ◽  
...  

Background/aims: Our understanding of predictors of post-thrombotic syndrome (PTS) in children is evolving. The present study aimed to investigate differences in patient- and DVT-related characteristics between central venous catheter (CVC) and non-CVC-related thrombosis in children and to study early PTS predictors. Methods: Children aged 0-18 years were recruited ≥6 months after imaging-proven upper (UE) or lower extremity (LE) DVT. PTS was measured using CAPTSure©. Early predictors included age at DVT diagnosis, symptoms, DVT burden, and days on therapeutic anticoagulation within 30 days post-DVT. Analysis of predictors was stratified in CVC and non-CVC-related thrombosis. Generalized estimating equations were used for data analyses. Results: In total, 313 DVT-affected extremities of 256 patients were assessed; 275 (88%) DVT were CVC-related. Patients with non-CVC-related thrombosis were older (median 5.8 years, 25th-75th percentile 4.9-6.4 vs. 3.5 months, 25th-75th percentile 0.7-18.7, p<0.001), and had positive thrombophilia (64% vs 22%, p<0.001) and obesity (30% vs. 13%, p=0.01) more frequently than patients with CVC-related thrombosis. PTS CAPTSure© scores were 9.5 points higher (standard error 3.0, p=0.02) in the non-CVC-related thrombosis stratum. Age at the time of DVT predicted PTS in both strata; DVT burden and time from DVT diagnosis to PTS assessment predicted PTS in CVC-related thrombosis. Conclusions: PTS severity was higher in non-CVC-related than in CVC-related thrombosis. Increasing age at the time of DVT is associated with higher PTS severity. DVT burden and time from DVT diagnosis to PTS assessment are significant PTS predictors in CVC-related thrombosis, indicating that long-term follow up of these children is important.


BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049557
Author(s):  
Jean Philippe Galanaud ◽  
Jameel Abdulrehman ◽  
A Lazo-Langner ◽  
Grégoire Le Gal ◽  
Sudeep Shivakumar ◽  
...  

IntroductionAfter deep vein thrombosis, up to 50% of patients develop post-thrombotic syndrome (PTS). PTS is a chronic condition that reduces quality of life (QOL). Cornerstones of PTS treatment include the use of elastic compression stockings but this treatment is usually incompletely effective and is burdensome. Venoactive drugs have been reported to be effective to treat chronic venous insufficiency (CVI). However, the level of evidence supporting their use in CVI in general and in PTS in particular is low.Methods and analysisThe MUFFIN-PTS trial is an academic, publically funded, multicentre randomised placebo-controlled trial assessing the efficacy of micronised purified flavonoid fraction (MPFF, Venixxa), a venoactive drug, to treat PTS. Eighty-six patients with PTS (Villalta score (VS) ≥5) and experiencing at least two of the following PTS manifestations among daily leg heaviness, cramps, pain or oedema will be randomised to receive 1000 mg of oral MPFF or a similar appearing placebo for 6 months, in addition to their usual PTS treatment. Total study follow-up will be 9 months, with visits at inclusion/baseline, 3, 6 and 9 months. Primary outcome is the proportion of patients with improvement in VS in each group, where improvement is defined as a decrease of at least 30% in VS or a VS <5 in the PTS-affected leg. Main secondary outcomes include QOL and patient satisfaction.Ethics and disseminationPrimary ethics approval was received from Centre intégré universitaire de santé et de services sociaux (CIUSSS) West-Central Montreal Research Ethics Board. Results of the study will be disseminated via peer-reviewed publications and presentations at scientific conferences.Trial registration numberClinicalTrials.gov Registry (NCT03833024); Pre-results.


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