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

Galanaud, Jean‐Philippe; Monréal, Manuel; Kahn, Susan R.

doi:10.1016/j.jvsv.2015.08.005

Cited by 42 publications

(54 citation statements)

References 34 publications

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“…Proximal DVT patients treated with warfarin are at higher risk of developing PTS if they have subtherapeutic international normalized ratio (INR) tests more than half of the time during the initial 3 months of treatment of DVT (compared to patients who have better INR control), or compared to patients treated with extended low molecular weight heparin (LMWH) or direct oral anticoagulants (DOAC) . Given the absence of other simple and effective measures to prevent PTS, optimal anticoagulation constitutes an easy and effective way to reduce the risk of PTS after a DVT …”

Section: Introductionmentioning

confidence: 99%

“…Given the absence of other simple and effective measures to prevent PTS, optimal anticoagulation constitutes an easy and effective way to reduce the risk of PTS after a DVT. 2,7 After an isolated distal DVT (infra-popliteal DVT without pulmonary embolism, referred to as distal DVT throughout this article), the risk of developing PTS and the impact of anticoagulant treatment on this risk are uncertain. As distal DVT is frequent and accounts for up to half of all lower limb DVT, [8][9][10][11] this is an important knowledge gap.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS‐PTS study

Galanaud

Righini

Collen

et al. 2020

Journal of Thrombosis and Haemostasis

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Background After a proximal lower limb deep vein thrombosis (DVT; involving popliteal veins or above), up to 40% of patients develop postthrombotic syndrome (PTS) as assessed by the Villalta scale (VS). Poor initial anticoagulant treatment is a known risk factor for PTS. The risk of developing PTS after isolated distal DVT (infra‐popliteal DVT without pulmonary embolism), and the impact of anticoagulant treatment on this risk, are uncertain. Methods Long‐term follow‐up of CACTUS double‐blind trial comparing 6 weeks of s.c. nadroparin (171 IU/kg/d) versus s.c. placebo for a first symptomatic isolated distal DVT. At least 1 year after randomization, patients had a PTS assessment in clinic or by phone using the VS. Results After a median follow‐up of 6 years, PTS was present in 30% (n = 54) of the 178 patients who had a PTS assessment. PTS was moderate or severe in 24% (n = 13) of cases. There was no statistically significant difference in prevalence of PTS in the nadroparin versus placebo groups (29% versus 32%, P = .6), except in patients without evidence of primary chronic venous insufficiency (9% versus 24%, P = .04). Rates of venous thromboembolism recurrence during follow‐up in the nadroparin and placebo groups were, respectively, 8% (n = 7) and 14% (n = 13; P = .2). Conclusion After a first isolated distal DVT, the risk of PTS is substantial but much lower than that reported after proximal DVT. Anticoagulation with nadroparin doesn't provide any clear benefit to prevent PTS, except in patients without preexisting chronic venous insufficiency. Anticoagulation might be associated with a lower risk of venous thromboembolism recurrence.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long‐term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS‐PTS study

Galanaud

Righini

Collen

et al. 2020

Journal of Thrombosis and Haemostasis

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“…It is acknowledged that the clinical presentation of PTS is non-speci c and conditions as primary venous insu ency, trauma, central venous hypertension, and arthrosis may present with similar clinical manifestations (25,31). Moreover, reported predictors of PTS are overlapping with predictors of primary venous insu ciency (29,33). Galanaud et al used data from the REVERSE study to assess risk factors for PTS in patients with a rst unprovoked proximal DVT who were free of clinically signi cant primary venous insu ciency with an effort to remove biased evaluation of PTS.…”

Section: Discussionmentioning

confidence: 99%

“…As there is no curative treatment for PTS (16), identi cation of predictors of PTS may help identifying patients at risk of developing PTS, facilitate PTS prevention, and guide in the development toward improved PTS management and care (33). Previous studies of PTS predictors have mainly used the Villalta scale for PTS assessment (1,2,(34)(35)(36)(37)(38)(39)(40)(41).…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies of PTS predictors have mainly used the Villalta scale for PTS assessment (1,2,(34)(35)(36)(37)(38)(39)(40)(41). However, the predictors identi ed have not been consistent across studies and have included proximal DVT, recurrent ipsilateral DVT, provoked DVT, preexisting chronic venous insu ciency, obesity, smoking, older age, thrombophilia, deep venous re ux, and persistent venous obstruction (16,33,42). Some studies have found men to be at higher risk; others have found the opposite (2,43,44).…”

Section: Introductionmentioning

confidence: 99%

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

Engeseth¹,

Enden²,

Sandset³

et al. 2020

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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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Sequelae and post‐thrombotic syndrome after venous thromboembolism in acute lymphoblastic leukemia survivors treated on the NOPHO ALL2008 protocol

Dam,

Lynggaard,

Jónsson

et al. 2024

Pediatric Blood & Cancer

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The treatment of acute lymphoblastic leukemia (ALL) is frequently complicated by toxicity, including venous thromboembolism (VTE) affecting roughly 8% of patients. VTE can lead to post‐thrombotic syndrome (PTS), a group of signs and symptoms developed as a complication to deep venous thrombosis (DVT), imposing risk of permanent disability and reduced quality of life (QoL). PTS prevalence ranges from 0% to 70%, reflecting very heterogenous cohorts and assessment tools. We aimed to estimate sequelae, including PTS and QoL in children and adults (<45 years old) who had a DVT during ALL treatment. PTS and QoL scores were obtained through use of Villalta and Modified Villalta Scale, PedsQL, and Short Form‐36 questionnaires. The cohort comprised 20 children (<18 years) and seven adults (median age: 12.9 years, range: 2–44 years) at the time of DVT diagnosis. In total, 25 ALL survivors underwent PTS examination. The examination took place when survivors were 7–48 years (median age: 20.3 years, median follow‐up time 6.8 years). QoL was assessed correlating cases with three matching ALL survivors without VTE. Two adults (15.4%) showed mild or moderate PTS. Eight children (66.7%) were diagnosed with mild PTS, while three cases had collaterals as sole symptoms. Pain or symptoms affecting daily life were reported by 16%. No difference in QoL was found (p = .9). This study underscores the need for comprehensive population‐based investigations with validation of PTS instruments in ALL survivors.

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

Cited by 42 publications

References 34 publications

Long‐term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS‐PTS study

Long‐term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS‐PTS study

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

Sequelae and post‐thrombotic syndrome after venous thromboembolism in acute lymphoblastic leukemia survivors treated on the NOPHO ALL2008 protocol

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