The Post-thrombotic Syndrome: The Forgotten Morbidity of Deep Venous Thrombosis

Kahn, Susan R.

doi:10.1007/s11239-006-5574-9

Cited by 101 publications

(68 citation statements)

References 92 publications

(82 reference statements)

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“…Post-thrombotic syndrome (PTS) occurs frequently after deep venous thrombosis (DVT), with a cumulative incidence of 20-50% within 2 years [1][2][3]. PTS is difficult to treat, leads to important morbidity and incurs high costs [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

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Relation between D‐dimer level, venous valvular reflux and the development of post‐thrombotic syndrome after deep vein thrombosis

Latella

Desmarais

Miron

et al. 2010

Journal of Thrombosis and Haemostasis

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Summary. Background: The pathophysiology of post-thrombotic syndrome (PTS) is postulated to involve persistent venous obstruction and venous valvular reflux. Objective: To study the association between D-dimer level, valvular reflux and the PTS in a well-defined cohort of deep vein thrombosis (DVT) patients. Methods: Consecutive patients with acute symptomatic DVT were recruited at eight centers and were followed for 24 months. D-dimer was measured at 4 months. A standardized ultrasound assessment for popliteal valvular reflux was performed at 12 months. Using the Villalta scale, patients were assessed for PTS during follow-up by evaluators who were unaware of D-dimer or reflux results. Results: Three hundred and eighty-seven patients were recruited; of these, 305 provided blood samples for D-dimer and 233 had a 12-month reflux assessment. PTS developed in 45.1% of subjects. Mean Ddimer was significantly higher in patients with vs. without PTS (712.0 vs. 444.0 lg L )1 ; P = 0.02). In logistic regression analyses adjusted for warfarin use at the time of D-dimer determination and risk factors for PTS, D-dimer level significantly predicted PTS (P = 0.03); when stratifying for warfarin use at the time of blood draw, adjusted odds ratio (OR) for developing PTS per unit difference in log D-dimer was 2.33 (95% CI 0.89, 6.10) in those not on warfarin vs. 1.25 (95% CI 0.87, 1.79) in those on warfarin. Ipsilateral reflux was more frequent in patients with moderate-to-severe PTS than in patients with mild PTS (65% vs. 40%, respectively; P = 0.01) and was independently associated with moderate-to-severe PTS in logistic regression analyses (P = 0.01). Conclusion: D-dimer levels, measured 4 months after DVT in patients not on warfarin, are associated with subsequent development of PTS. Venous valvular reflux is associated with moderate-to-severe PTS.

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Section: Introductionmentioning

confidence: 99%

“…PTS is difficult to treat, leads to important morbidity and incurs high costs [1][2][3]. Patients who develop PTS report heaviness, pain, cramps, pruritis and paresthesias in the affected limb.…”

Section: Introductionmentioning

confidence: 99%

Relation between D‐dimer level, venous valvular reflux and the development of post‐thrombotic syndrome after deep vein thrombosis

Latella

Desmarais

Miron

et al. 2010

Journal of Thrombosis and Haemostasis

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“…In Brazil, Ramacciotti et al calculated that average annual cost was US$ 400 for moderate cases and US$ 1,200 for more serious PTS cases 26 . According to Susan and Kahn, around 20 to 50% of patients with idiopathic DVT will develop PTS 6 . intima, localized fibrinolysis and fragmentation of the thrombus after cellular invasion by newly formed vessels 28,29 .…”

Section: Postthrombotic Syndromementioning

confidence: 99%

“…Many different authors have proposed definitions of PTS based on combinations of clinical symptoms and signs, evidence of venous obstructions, elevated venous pressure or valve reflux, identified on the basis of ultrasound and/or plethysmograph findings. While a diagnosis of PTS cannot be made in the absence of these clinical signs, the majority of symptomatic patients exhibit valve incompetence, although many people with incompetence do not manifest PTS clinically 6,27 . Therefore, delayed recanalization after a thrombotic episode appears to be an important predictor of PTS development.…”

Section: Postthrombotic Syndrome and Venous Recanalizationmentioning

confidence: 99%

Recanalization after acute deep vein thrombosis

2013

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The process of recanalization of the veins of the lower limbs after an episode of acute deep venous thrombosis is part of the natural evolution of the remodeling of the venous thrombus in patients on anticoagulation with heparin and vitamin K inhibitors. This remodeling involves the complex process of adhesion of thrombus to the wall of the vein, the inflammatory response of the vessel wall leading to organization and subsequent contraction of the thrombus, neovascularization and spontaneous lysis of areas within the thrombus. The occurrence of spontaneous arterial flow in recanalized thrombosed veins has been described as secondary to neovascularization and is characterized by the development of flow patterns characteristic of arteriovenous fistulae that can be identified by color duplex scanning. In this review, we discuss some controversial aspects of the natural history of deep vein thrombosis to provide a better understanding of its course and its impact on venous disease.Keywords: venous thrombosis; ultrasonography Doppler color; review literature as topic. ResumoO processo de recanalização das veias dos membros inferiores, após um episódio de trombose venosa profunda aguda em pacientes anticoagulados com heparina e inibidores da vitamina K, faz parte da evolução natural da remodelagem do trombo venoso. Esse complexo processo de remodelagem envolve a adesão do trombo à parede da veia, à resposta inflamatória da parede do vaso, levando à organização e subsequente contração do trombo, à neovascularização e à lise espontânea de áreas no interior do trombo. A presença de fluxo arterial espontâneo em veias com trombose recanalizada tem sido descrita como secundária à neovascularização e se caracteriza pelo desenvolvimento de fluxo com padrão de fístulas arteriovenosas, identificadas por meio de mapeamento dúplex colorido. Nesta revisão, são discutidos alguns aspectos controversos da história natural da trombose venosa profunda, para uma melhor compreensão da sua evolução e do seu impacto sobre a doença venosa.Palavras-chave: trombose venosa; ultrassonografia Doppler em cores; literatura de revisão como assunto.

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“…The negative repercussion of PTS is largely due to its difficult, costly, and frustrating treatment (11,12).…”

Section: Introductionmentioning

confidence: 99%

Pediatric post-thrombotic syndrome in children: Toward the development of a new diagnostic and evaluative measurement tool

Avila

Brandão

Williams

et al. 2016

Thrombosis Research

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Objective: Our goal was to conduct the generation and piloting of a discriminative and evaluative tool for pediatric post-thrombotic syndrome.Methods: We followed a formative model for the development of the tool, focusing on the signs/symptoms (items) that define post-thrombotic syndrome. For item generation, pediatric thrombosis experts and diagnosed with extremity post-thrombotic syndrome during childhood nominated items. In the piloting phase, items were cross-sectionally measured in children with limb deep vein thrombosis to examine the performance of the items.Result: Twenty-three experts and 16 subjects listed 34 items, which were then measured in 140 subjects with previous diagnosis of limb deep vein thrombosis (70 upper extremity and 70 lower extremity). The items with strongest correlation with post-thrombotic syndrome severity and largest area under the curve were pain (in older children), paresthesia, and swollen limb for the upper extremity group, and pain (in older children), tired limb, heaviness, tightness and paresthesia for the lower extremity group.Conclusion: Diagnostic properties and correlation with post-thrombotic syndrome severity of the different signs and symptoms varied according to the assessed venous territory.The information gathered in this study will help experts decide which item should be considered for inclusion in the new tool.

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The Post-thrombotic Syndrome: The Forgotten Morbidity of Deep Venous Thrombosis

Cited by 101 publications

References 92 publications

Relation between D‐dimer level, venous valvular reflux and the development of post‐thrombotic syndrome after deep vein thrombosis

Relation between D‐dimer level, venous valvular reflux and the development of post‐thrombotic syndrome after deep vein thrombosis

Recanalization after acute deep vein thrombosis

Pediatric post-thrombotic syndrome in children: Toward the development of a new diagnostic and evaluative measurement tool

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