Inflammation markers and their trajectories after deep vein thrombosis in relation to risk of post‐thrombotic syndrome

Abstract

Summary. Background: Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT). Objective: In the BioSOX study, we investigated whether inflammation markers predict the risk of PTS after DVT. Methods: We measured C-reactive protein (CRP), ICAM-1, interleukin (IL)-6, and IL-10, at baseline, and 1 month and 6 months after a first proximal DVT, among 803 participants in the SOX trial. Participants were prospectively followed for 24 months for development of PTS. Results: Median CRP levels at 1 month, ICAM-1 levels at baseline, 1 month and 6 months, IL-6 levels at 1 month and 6 months and IL-10 levels at 6 months were higher in patients who developed PTS than in those who did not. Multivariable regression with the median as a cutoff showed risk ratios (RRs) for PTS of 1.23 (95% confidence interval [CI] 1.05-1.45) and 1.25 (95% CI 1.05-1.48) for ICAM-1 at 1 month and 6 months, respectively, and 1.27 (95% CI 1.07-1.51) for IL-10 at 6 months. Quartile-based analysis demonstrated a dose-response association between ICAM-1 and PTS. ICAM-1 and IL-10 were also associated with PTS severity. Analysis of biomarker trajectories after DVT demonstrated an association between the highest-trajectory group of ICAM-1 and PTS. Conclusions: In this prospective study, ICAM-1 over time was most consistently associated with the risk of PTS. Further study is required to confirm these findings and assess their potential clinical relevance.

Reduced plasma fibrin clot permeability and susceptibility to lysis are associated with increased risk of postthrombotic syndrome

“…Regarding known and possible factors associated with PTS, including older age, higher BMI, increased D-dimer levels and elevated CRP, the current study is consistent with most reports [3,5,16,[32][33][34][35]. Contrary to a few studies [3,7,9,34], we identified isolated and unprovoked DVT as an independent predictor of PTS, which is likely to be due to a close association of this type of VTE with proximal DVT in our study.…”

“…A number of studies have shown that PTS is closely associated with systemic inflammation and subsequent tissue remodeling and fibrosis [5,16]. Given reports on unfavorable clot properties in inflammatory states [10,11], we hypothesized that a prothrombotic clot phenotype is associated with a future risk of PTS.…”

Association between small‐intestinal bacterial overgrowth and deep vein thrombosis in patients with spinal cord injuries

“…Rabinovich et al . found that inflammation markers such as ICAM‐1 predict the risk of post‐thrombotic syndrome after DVT. Second, conditions that increase bacterial translocation have been implicated in the development of VT through higher circulating levels of lipopolysaccharide (LPS) along with increased expression of Toll‐like receptor 4 (TLR‐4), an innate immune receptor that is responsible for LPS recognition .…”

Predictors of the post-thrombotic syndrome and their effect on the therapeutic management of deep vein thrombosis

“…It has been shown that patients with PTS had higher levels of markers of inflammation such as C-reactive protein, intercellular adhesion molecule-1 and interleukin 6 than those who do not develop PTS. 13,29,30 To our knowledge, to date no trial has been conducted to assess the effectiveness of anti-inflammatory drugs per se to prevent PTS. Regarding fibrinolysis, high D-dimer levels at various time points after DVT are associated with increased risk of PTS.…”