Inflammatory response in the acute phase of deep vein thrombosis

Roumen-Klappe, Edith M.; Heijer, Martin den; Uum, Stan H. M. Van; Ven-Jongekrijg, J. van der; Graaf, F. van der; Wollersheim, Hub

doi:10.1067/mva.2002.121746

Cited by 147 publications

(132 citation statements)

References 19 publications

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“…Increased levels of serum C-reactive protein (CRP), a marker of systemic inflammation, have been reported in patients with venous thrombosis and PE (Roumen-Klappe et al, 2002). The CRP assay is cheap and readily available 24 h a day in most hospitals.…”

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confidence: 99%

C‐reactive protein and D‐dimer with clinical probability score in the exclusion of pulmonary embolism

et al. 2005

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SummaryThis study evaluated the diagnostic value of C-reactive protein (CRP) combined with a clinical decision rule in the exclusion of pulmonary embolism (PE) and compared this with D-dimer. In 363 consecutive outpatients CRP and D-dimer test were performed and clinical probability of PE was assessed. Patients with D-dimer levels <500 lg/l and clinical probability indicating 'PE unlikely' were followed for 3 months. Ventilation-perfusion scan or spiral computerized tomography was performed in patients with D-dimer levels ‡500 lg/l or clinical probability indicating 'PE likely'. The CRP had a sensitivity of 95AE7% [95% confidence interval (CI): 90-100] and negative predictive value (NPV) of 98AE4% (96-100). CRP <5 mg/l with clinical probability score indicating 'PE unlikely' (n ¼ 108, 30%), had a sensitivity of 96AE7% (90-100), a specificity of 43AE0% (37-49) and NPV of 99AE1% (97-100). D-dimer <500 lg/l with clinical probability score indicating 'PE unlikely' (n ¼ 170, 51%), had a sensitivity of 96AE7% (90-100), a specificity of 67AE9% (62-74) and NPV of 99AE4% (98-100). Based on retrospective data it was concluded that a standard CRP test can potentially be used to safely exclude PE, either as a sole test or combined with clinical probability assessment. Prospective studies are needed to confirm these findings.

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C‐reactive protein and D‐dimer with clinical probability score in the exclusion of pulmonary embolism

et al. 2005

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“…Follow-up studies of patients with DVT who were treated with anticoagulants have shown that in many cases only partial clearance of the thrombus occurs. [29][30][31][32] Damage to venous valves leading to valvular reflux occurs frequently after DVT, probably by thrombus-induced activation of inflammation, fibrous scarring associated with acute and resolving thrombosis, or venous dilation distal to the obstructed venous segment [33][34][35][36] (Figure 2). Of the 2 mechanisms, persistent venous obstruction appears to be the more important; on the basis of 2 recent reports, the presence of residual venous obstruction 6 months after DVT alone or in combination with venous reflux predicted the development of PTS, whereas the presence of venous reflux alone did not.…”

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How I treat postthrombotic syndrome

Kahn

2009

Blood

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Postthrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT) that reduces quality of life and has important socioeconomic consequences. More than one-third of patients with DVT will develop PTS, and 5% to 10% of patients will develop severe PTS, which may manifest as venous ulceration. The principal risk factors for PTS are persistent leg symptoms 1 month after the acute episode of DVT, extensive DVT, recurrent ipsilateral DVT, obesity, and older age. Daily use of elastic compression stockings (ECSs) for 2 years after proximal DVT appears to reduce the risk of PTS; however, there is uncertainty about optimal duration of use and compression strength of ECSs and the magnitude of their effect. The cornerstone of managing PTS is compression therapy, primarily using ECSs. IntroductionDeep vein thrombosis (DVT) is a common vascular condition that is associated with significant rates of morbidity and mortality. Although pulmonary embolism and recurrent venous thrombosis are well-known consequences of DVT, an important, underappreciated, chronic consequence of DVT is postthrombotic syndrome (PTS). PTS develops in 20% to 50% of patients with DVT, 1,2 even when appropriate anticoagulant therapy is prescribed to treat the DVT. On the basis of its high incidence and prevalence, PTS is the single most frequent complication of DVT.Some practitioners may believe that PTS is primarily a cosmetic or "nuisance" problem. To the contrary, PTS is burdensome and potentially debilitating to patients, and it is a condition for which patients frequently seek medical advice. Manifestations of PTS vary from mild clinical symptoms or signs to more severe manifestations such as chronic leg pain that limits activity and ability to work, intractable edema, and leg ulcers. 3 PTS has been shown to have significant, adverse effects on quality of life and productivity, [4][5][6] and is costly as measured by health resource utilization, direct costs, and indirect costs. [7][8][9] In this review, I address the following questions: (1) How is PTS diagnosed? (2) Can we identify patients with DVT who are at risk of developing PTS? (3) How can PTS be prevented? (4) How do I treat PTS? and (5) What are the gaps in our understanding of PTS that should be addressed by future research? I also address upper-extremity PTS and the responsibility to discuss long-term prognosis with patients with DVT. This paper focuses on PTS in adults. Readers with an interest in PTS in children are referred to a recent review of this topic. 10 How I diagnose PTS Clinical presentation of PTSPTS is termed a "syndrome" because it is associated with groupings of symptoms and clinical signs that typically vary from patient to patient (Table 1). Patients with PTS experience aching pain, heaviness, swelling, cramps, itching, or tingling in the affected limb. Symptoms may be present in various combinations and may be persistent or intermittent. Typically, symptoms are aggravated by standing or walking and improve with resting, leg elevation, and lying dow...

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“…Es en este punto donde los reactantes de fase aguda y los marcadores de inflamación podrían desempeñar un papel importante. Es bien conocido que la inflamación crónica es un factor de riesgo para la ateroesclerosis y que la elevación de los marcadores de inflamación están asociados a eventos coronarios (2). Esta relación está menos demostrada en la ETEV.…”

Section: Abstract Objective: To Assess the Association Of Acute Reactunclassified

Reactantes de fase aguda y marcadores de inflamación en pacientes con enfermedad tromboembólica venosa: correlación con parámetros clínicos y evolutivos

Yglesias

Rodríguez

Martínez

et al. 2006

An. Med. Interna (Madrid)

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Inflammatory response in the acute phase of deep vein thrombosis

Cited by 147 publications

References 19 publications

C‐reactive protein and D‐dimer with clinical probability score in the exclusion of pulmonary embolism

C‐reactive protein and D‐dimer with clinical probability score in the exclusion of pulmonary embolism

How I treat postthrombotic syndrome

Reactantes de fase aguda y marcadores de inflamación en pacientes con enfermedad tromboembólica venosa: correlación con parámetros clínicos y evolutivos

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