Recurrence and Late Sequelae after First-Time Deep Vein Thrombosis: Relationship to Initial Signs

Abstract

Objective: To investigate the relation between initial symptoms and long-term sequelae in first-time deep venous thrombosis (DVT). Design: Follow-up study of patients 6 years after an episode of suspected symptomatic DVT. Setting: Vascular laboratory, University Hospital of Lund. Patients: 66 patients, 19 with femoral DVT, 20 with calf DVT and 27 with normal phlebograms at initial investigation. Main outcome measures: Symptoms and signs of chronic venous insufficiency (CVI), foot volumetry and measurement of plasminogen activator inhibitor 1 (PAI-1) activity. Initial clinical signs and results at phlebography were compared with findings at follow-up. Results: Of patients with DVT, 11 (28%) had been treated for a recurrent DVT during follow-up. No relation was found between initial signs of DVT and late signs of CVI. Patients with DVT had significantly more signs of CVI but symptoms did not differ between the groups. Mean levels of PAI-1 activity were similar in the three groups, and patients with recurrent DVT did not differ. Refilling flow was related to the clinical CVI-score, and expelled volume was inversely related to the extension of DVT at phlebography. Conclusion: The recurrence rate is high in first-time DVT, but symptoms are mostly mild as long as after 6 years. There is a poor correlation between symptoms of CVI and objective findings. The late development of CVI cannot be predicted from the clinical signs in the acute phase. Levels of PAI-1 do not correlate with the degree of CVI.

A multicentre comparison of once‐daily subcutaneous dalteparin (low molecular weight heparin) and continuous intravenous heparin in the treatment of deep vein thrombosis

“…It is difficult to discount the possibility that a decreased Marder score did not coincide with a silent PE, since lung scans were only taken to assist diagnosis of symptomatic PE. However, the low 6month recurrence rates with dalteparin (3.1 %) and heparin (1.9 %) compared with those obtained by Lagerstedt et al who reported 8 % recurrence within 1 year and 28 % within 6 years [12], suggest that this was not a frequent occurrence, if indeed it happened at all. In the study by Prandoni et al [1] the incidence of new segmental defects after the initial treatment period was 5 % in the LMWH group and 19 % in the UFH group, all without any symptoms.…”

Postthrombotic syndrome after isolated calf deep venous thrombosis: The role of popliteal reflux

“…2 Several studies have shown that the incidence of the postthrombotic syndrome is quite equal when distal and more proximal DVTs are compared. [12][13][14] It has been argued that an isolated cDVT may be treated without anticoagulant therapy in cases with no propagation into proximal veins. 1,8 Several hemodynamic events may occur after DVT, but their significance to late outcome is poorly defined, such as propagation into proximal segments after cDVT, 6 reflux in the initially uninvolved segments, 10 and recurrent DVT.…”

Chronic Venous Insufficiency and Venous Ulceration

“…29 Some caution is needed in interpreting the findings as 64% of the original cohort group was lost to follow-up.…”

“…In one prosecutive, controlled study, patients with proximal DVT had more pigmentation and pitting edema than control subjects or patients with distal DVT; however, symptoms of aching pain, morning swelling, itching, or the need to wear compression stockings were not different among the three groups. 29 Some caution is needed in interpreting the findings as 64% of the original cohort group was lost to follow-up.…”