Symptomatic deep-vein thrombosis and the post-thrombotic syndrome

Prandoni, Paolo; Lensing, A.W.A.; Büller, Harry R.; Villalta, Sabina; Carta, M.; Polistena, P.; Cogo, Alberto; Cate, J. W. Ten

doi:10.1016/0049-3848(92)90410-c

Cited by 15 publications

(19 citation statements)

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“…Findings with the use of a standardized PTS scoring system were first reported in 2003 in a retrospective analysis by the Childhood Thrombophilia Program at the Hospital for Sick Children 8 in 153 children with a history of UE/LE DVT. This study employed a pediatric adaptation of the Villalta PTS scoring system, 75 and defined a striking frequency of 63% for the occurrence of PTS in children with a history of limb DVT, at an average follow-up duration of 16 months post-event. By comparison, a prospective cohort including 52 unselected cases of acute UE/LE DVT found a PTS incidence of 33% at 1-2 years post-event, using the Manco-Johnson instrument.…”

Section: Frequency Of Post-thrombotic Syndrome Occurrencementioning

confidence: 99%

Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors

Goldenberg¹,

Donadini²,

Kahn³

et al. 2010

Haematologica

181

149

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BackgroundPost-thrombotic syndrome is a manifestation of chronic venous insufficiency following deep venous thrombosis. This systematic review was conducted to critically evaluate pediatric evidence on frequency of occurrence, validity of outcome measures, and prognostic indicators of post-thrombotic syndrome. Design and MethodsA comprehensive literature search of original reports revealed 19 eligible studies, totaling 977 patients with upper/lower extremity deep venous thrombosis. Calculated weighted mean frequency of post-thrombotic syndrome was 26% (95% confidence interval: 23-28%) overall, and differed significantly by prospective/non-prospective analysis and use/non-use of a standardized outcome measure. ResultsStandardized post-thrombotic syndrome outcome measures included an adaptation of the Villalta scale, the Clinical-Etiologic-Anatomic-Pathologic classification, and the Manco-Johnson instrument. Data on validity were reported only for the Manco-Johnson instrument. No publications on post-thrombotic syndrome-related quality of life outcomes were identified. Candidate prognostic factors for post-thrombotic syndrome in prospective studies included use/non-use of thrombolysis and plasma levels of factor VIII activity and D-dimer. ConclusionsGiven that affected children must endure chronic sequelae for many decades, it is imperative that future collaborative pediatric prospective cohort studies and trials assess as key objectives and outcomes the incidence, severity, prognostic indicators, and health impact of post-thrombotic syndrome, using validated measures.

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Section: Frequency Of Post-thrombotic Syndrome Occurrencementioning

confidence: 99%

Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors

Goldenberg¹,

Donadini²,

Kahn³

et al. 2010

Haematologica

181

149

View full text Add to dashboard Cite

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“…Although less dramatic than PE, post-thrombotic syndrome is responsible for the greater degree of chronic socioeconomic morbidity. As many as 29 to 79% of patients may have long term manifestation of pain, edema, hyperpigmentation, or ulceration after an episode of acute DVT [4][5][6]. Severe manifestations and ulceration occur in 4% to 6% and 7% to 23%, respectively [7,8].…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of Post-Thrombotic Syndrome: The Effect of Recurrent Venous Thrombosis and Inherited Thrombophilia

Kreidy

2011

ISRN Vascular Medicine

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Post-thrombotic syndrome is an important chronic complication of deep vein thrombosis. This syndrome can be debilitating to patients and has a major economic impact on health care services. The pathophysiology of post-thrombotic syndrome is currently incompletely understood. Because therapeutic options for post-thrombotic syndrome are extremely limited and results are often disappointing, recognizing of the pathophysiology and risk factors of this syndrome is essential to prevent the disabling consequences of this disease. The present paper focuses on risk determinants of post-thrombotic syndrome after deep vein thrombosis. The contribution of recurrent venous thrombosis and inherited thrombophilia to the pathogenesis of this syndrome is reviewed and discussed in details.

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“…Differentiating between the two is important as recurrent DVT carries the risk of pulmonary embolism and more severe post-thrombotic manifestations. 78,79 The risk of recurrent DVT has been reported to be 17% at 2 years, 25% at 5 years, and 30% at 8 years and is significantly higher in patients with malignancy or hypercoagulable states when compared with those whose original episode was associated with surgery or recent trauma. [79][80][81] Unfortunately, differentiating acute from chronic thrombus may be challenging for most diagnostic modalities.…”

Section: Duplex Ultrasonographymentioning

confidence: 97%

The hemodynamics and diagnosis of venous disease

Meissner

Moneta

Burnand

et al. 2007

Journal of Vascular Surgery

317

233

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The venous system is, in many respects, more complex than the arterial system and a thorough understanding of venous anatomy, pathophysiology, and available diagnostic tests is required in the management of acute and chronic venous disorders. The venous system develops through several stages, which may be associated with a number of development anomalies. A thorough knowledge of lower extremity venous anatomy, anatomic variants, and the recently updated nomenclature is required of all venous practitioners. Effective venous return from the lower extremities requires the interaction of the heart, a pressure gradient, the peripheral muscle pumps of the leg, and competent venous valves. In the absence of pathology, this system functions to reduce venous pressure from approximately 100 mm Hg to a mean of 22 mm Hg within a few steps. The severe manifestations of chronic venous insufficiency result from ambulatory venous hypertension, or a failure to reduce venous pressure with exercise. Although the precise mechanism remains unclear, venous hypertension is thought to induce the associated skin changes through a number of inflammatory mechanisms. Several diagnostic tests are available for the evaluation of acute and chronic venous disease. Although venous duplex ultrasonography has become the standard for detection of acute deep venous thrombosis, adjuvant modalities such as contrast, computed tomographic, and magnetic resonance venography have an increasing role. Duplex ultrasonography is also the most useful test for detecting and localizing chronic venous obstruction and valvular incompetence. However, it provides relatively little quantitative hemodynamic information and is often combined with measurements of hemodynamic severity determined by a number of plethysmographic methods. Finally, critical assessment of venous treatment modalities requires an understanding of the objective clinical outcome and quality of life instruments available.

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Symptomatic deep-vein thrombosis and the post-thrombotic syndrome

Cited by 15 publications

References 0 publications

Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors

Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors

Pathophysiology of Post-Thrombotic Syndrome: The Effect of Recurrent Venous Thrombosis and Inherited Thrombophilia

The hemodynamics and diagnosis of venous disease

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