Prospective Studies on Diagnosis, Prevention, and Management of Deep Vein Thrombosis (DVT), DVT Recurrence and the Post-Thrombotic Syndrome (PTS): From Concept to Study Design in the Primary Care Setting

Abstract

Deep-Vein Thrombosis (DVT) Epidemiology DVT has an annual incidence of 0.2% in the urban population [1]. The disease is rare in children under 15 year of age, but its frequency increases with age, with an incidence of 1.8 per 1000 persons-years at age 65 to 69 years and 3.1 per 1000 persons-years at age 85 to 89 years [2,3]. First-time episodes of DVT are in two-thirds of cases elicited by risk factors, including cancer, immobility, or surgery. The prevalence of DVT is comparable in black and white adults and is low in Asian populations. Risk for DVT seems to be slightly higher in men than in women, and the risk of recurrence of venous thromboembolism is about 60% higher in men compared to women [4]. F a m ily Med ic in e & Me dica l S c ie n c e Resea rc h

Evidence-Based Novel Management Options of Acute Deep Vein Thrombosis (DVT) and Prevention of DVT Recurrence in Primary Care Medicine Anno 2018 - 2020

“…recurrence rate from about 30% to 3% patient/yrs during longterm follow-up [13,14]. Results of acute VTE treatment in the meta-nalysis of Mantha and Ansell [41] comparing each of the DOACs apixaban, dabigatran,rivaroxaban and edoxaban vs VKA in terms of recurrent VTE, and details of major bleeds or CRNM bleeds are summarized clearly showed that all DOACs are non-inferior to VKA with regard to thrombotic recurrence of VTE and death (Figure 6, table 6).…”

“…The C of CEAP in Table 2 start to appear at 6 and 12 months post-DVT and should be followed-up yearly thereafter. It is very well known that only half of the post-DVT patients with CEAP class 1 to 4 are asymptomatic [13,14]. follow-up in all and in males, but a significant reduction of PTS progression was observed in females [19].…”

“…Assessment of the risk on PTS by colour duplex ultrasonography (DUS) should be performed in acute DVT patients at 1 month, 3 and 6 months, 1 year, and 2 years post-DVT to determine whether there is still a need for wearing MECS, and to see whether additional treatment is necessary[2,13,14]. The Maastricht LET classification can be used to standardize the documentation DVT localization and extension at time of acute DVT diagnosis.The Maastricht LET classification[19] when combined with serial CUS at 1 and 3 months post-DVT is very helpful to identify optimal treatment options in patients with acute DVT in the primary care and hospital settings (Figures3 and 4)[2,13,14]. About one third to about half of acute DVT patients show rapid recanalization of proximal DVT with normal CUS at 3 months post-DVT (DACUS studies[25,26] and do not develop PTS after 3 -9 months post-DVT obviating the need to wear MECS and anticoagulation.…”

“…In the case of delayed recanalization and RVT is present at and after 3 months months post-DVT on CCUS careful prospective evaluation with regard to the need and duration of extended of anticoagulation using the Palareti's D-dimer strategy (Figure4). Patients with symptomatic PTS C 2, 3 and 4 seems to be candidates for extended anticoagulation preferentially with DOAC in a similar low dose as used in the post-operative orthopedic surgery setting (Figures3 and 4)[13,14]. Anticoagulant treatment of symptomatic distal calf vein thrombosis (LET class I) is mandatory to prevent DVT extension into the proximal popliteal and femoral veins [27-29].…”

“…and 4)[2,13,14,45,46]. Anticoagulant treatment of symptomatic distal calf vein thrombosis (CVT) is mandatory to prevent DVT extension into proximal deep veins.…”