Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency

J. P. Galanaud, C. A. Holcroft, M. A. Rodger, M. J. Kovacs, M. T. Betancourt, P. S. Wells, D. R. Anderson, I. Chagnon, G. Le Gal, S. Solymoss, M. A. Crowther, A. Perrier, Richard H White, L. M. Vickars, T. Ramsay, S. R. Kahn

Research output: Contribution to journalArticle

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Abstract

Background: Post-thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). Its diagnosis is based on clinical characteristics. However, symptoms and signs of PTS are non-specific, and could result from concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS. Methods: Using data from the REVERSE multicenter study, we assessed risk factors for PTS in patients with a first unprovoked unilateral proximal DVT 5-7 months earlier who were free of clinically significant PVI (defined as absence of moderate or severe venous ectasia in the contralateral leg). Results: Among the 328 patients considered, the prevalence of PTS was 27.1%. Obesity (odds ratio [OR] 2.6 [95% confidence interval (CI) 1.5-4.7]), mild contralateral venous ectasia (OR 2.2 [95% CI 1.1-4.3]), poor International Normalized Ratio (INR) control (OR per additional 1% of time with INR < 2 during anticoagulant treatment of 1.018 [95% CI 1.003-1.034]) and the presence of residual venous obstruction on ultrasound (OR 2.1 [95% CI 1.1-3.7]) significantly increased the risk for PTS in multivariable analyses. When we restricted our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n = 244), the prevalence of PTS decreased slightly to 24.6%. Only obesity remained an independent predictor of PTS (OR 2.6 [95% CI 1.3-5.0]). Poor INR control and residual venous obstruction also increased the risk, but the results were no longer statistically significant (OR 1.017 [95% CI 0.999-1.035] and OR 1.7 [95% CI 0.9-3.3], respectively). Conclusions: After a first unprovoked proximal DVT, obese patients and patients with even mild PVI constitute a group at increased risk of developing PTS for whom particular attention should be paid with respect to PTS prevention. Careful monitoring of anticoagulant treatment may prevent PTS.

Original languageEnglish (US)
Pages (from-to)474-480
Number of pages7
JournalJournal of Thrombosis and Haemostasis
Volume11
Issue number3
DOIs
StatePublished - Mar 2013

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Venous Insufficiency
Venous Thrombosis
Odds Ratio
Population
Confidence Intervals
International Normalized Ratio
Pathologic Dilatations
Anticoagulants
Obesity
Multicenter Studies
Signs and Symptoms
Leg

Keywords

  • Deep vein thrombosis
  • Post-thrombotic syndrome
  • Risk factors
  • Venous insufficiency
  • Venous thromboembolism
  • Villalta scale

ASJC Scopus subject areas

  • Hematology

Cite this

Galanaud, J. P., Holcroft, C. A., Rodger, M. A., Kovacs, M. J., Betancourt, M. T., Wells, P. S., ... Kahn, S. R. (2013). Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency. Journal of Thrombosis and Haemostasis, 11(3), 474-480. https://doi.org/10.1111/jth.12106

Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency. / Galanaud, J. P.; Holcroft, C. A.; Rodger, M. A.; Kovacs, M. J.; Betancourt, M. T.; Wells, P. S.; Anderson, D. R.; Chagnon, I.; Le Gal, G.; Solymoss, S.; Crowther, M. A.; Perrier, A.; White, Richard H; Vickars, L. M.; Ramsay, T.; Kahn, S. R.

In: Journal of Thrombosis and Haemostasis, Vol. 11, No. 3, 03.2013, p. 474-480.

Research output: Contribution to journalArticle

Galanaud, JP, Holcroft, CA, Rodger, MA, Kovacs, MJ, Betancourt, MT, Wells, PS, Anderson, DR, Chagnon, I, Le Gal, G, Solymoss, S, Crowther, MA, Perrier, A, White, RH, Vickars, LM, Ramsay, T & Kahn, SR 2013, 'Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency', Journal of Thrombosis and Haemostasis, vol. 11, no. 3, pp. 474-480. https://doi.org/10.1111/jth.12106
Galanaud, J. P. ; Holcroft, C. A. ; Rodger, M. A. ; Kovacs, M. J. ; Betancourt, M. T. ; Wells, P. S. ; Anderson, D. R. ; Chagnon, I. ; Le Gal, G. ; Solymoss, S. ; Crowther, M. A. ; Perrier, A. ; White, Richard H ; Vickars, L. M. ; Ramsay, T. ; Kahn, S. R. / Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency. In: Journal of Thrombosis and Haemostasis. 2013 ; Vol. 11, No. 3. pp. 474-480.
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abstract = "Background: Post-thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). Its diagnosis is based on clinical characteristics. However, symptoms and signs of PTS are non-specific, and could result from concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS. Methods: Using data from the REVERSE multicenter study, we assessed risk factors for PTS in patients with a first unprovoked unilateral proximal DVT 5-7 months earlier who were free of clinically significant PVI (defined as absence of moderate or severe venous ectasia in the contralateral leg). Results: Among the 328 patients considered, the prevalence of PTS was 27.1{\%}. Obesity (odds ratio [OR] 2.6 [95{\%} confidence interval (CI) 1.5-4.7]), mild contralateral venous ectasia (OR 2.2 [95{\%} CI 1.1-4.3]), poor International Normalized Ratio (INR) control (OR per additional 1{\%} of time with INR < 2 during anticoagulant treatment of 1.018 [95{\%} CI 1.003-1.034]) and the presence of residual venous obstruction on ultrasound (OR 2.1 [95{\%} CI 1.1-3.7]) significantly increased the risk for PTS in multivariable analyses. When we restricted our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n = 244), the prevalence of PTS decreased slightly to 24.6{\%}. Only obesity remained an independent predictor of PTS (OR 2.6 [95{\%} CI 1.3-5.0]). Poor INR control and residual venous obstruction also increased the risk, but the results were no longer statistically significant (OR 1.017 [95{\%} CI 0.999-1.035] and OR 1.7 [95{\%} CI 0.9-3.3], respectively). Conclusions: After a first unprovoked proximal DVT, obese patients and patients with even mild PVI constitute a group at increased risk of developing PTS for whom particular attention should be paid with respect to PTS prevention. Careful monitoring of anticoagulant treatment may prevent PTS.",
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T1 - Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency

AU - Galanaud, J. P.

AU - Holcroft, C. A.

AU - Rodger, M. A.

AU - Kovacs, M. J.

AU - Betancourt, M. T.

AU - Wells, P. S.

AU - Anderson, D. R.

AU - Chagnon, I.

AU - Le Gal, G.

AU - Solymoss, S.

AU - Crowther, M. A.

AU - Perrier, A.

AU - White, Richard H

AU - Vickars, L. M.

AU - Ramsay, T.

AU - Kahn, S. R.

PY - 2013/3

Y1 - 2013/3

N2 - Background: Post-thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). Its diagnosis is based on clinical characteristics. However, symptoms and signs of PTS are non-specific, and could result from concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS. Methods: Using data from the REVERSE multicenter study, we assessed risk factors for PTS in patients with a first unprovoked unilateral proximal DVT 5-7 months earlier who were free of clinically significant PVI (defined as absence of moderate or severe venous ectasia in the contralateral leg). Results: Among the 328 patients considered, the prevalence of PTS was 27.1%. Obesity (odds ratio [OR] 2.6 [95% confidence interval (CI) 1.5-4.7]), mild contralateral venous ectasia (OR 2.2 [95% CI 1.1-4.3]), poor International Normalized Ratio (INR) control (OR per additional 1% of time with INR < 2 during anticoagulant treatment of 1.018 [95% CI 1.003-1.034]) and the presence of residual venous obstruction on ultrasound (OR 2.1 [95% CI 1.1-3.7]) significantly increased the risk for PTS in multivariable analyses. When we restricted our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n = 244), the prevalence of PTS decreased slightly to 24.6%. Only obesity remained an independent predictor of PTS (OR 2.6 [95% CI 1.3-5.0]). Poor INR control and residual venous obstruction also increased the risk, but the results were no longer statistically significant (OR 1.017 [95% CI 0.999-1.035] and OR 1.7 [95% CI 0.9-3.3], respectively). Conclusions: After a first unprovoked proximal DVT, obese patients and patients with even mild PVI constitute a group at increased risk of developing PTS for whom particular attention should be paid with respect to PTS prevention. Careful monitoring of anticoagulant treatment may prevent PTS.

AB - Background: Post-thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). Its diagnosis is based on clinical characteristics. However, symptoms and signs of PTS are non-specific, and could result from concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS. Methods: Using data from the REVERSE multicenter study, we assessed risk factors for PTS in patients with a first unprovoked unilateral proximal DVT 5-7 months earlier who were free of clinically significant PVI (defined as absence of moderate or severe venous ectasia in the contralateral leg). Results: Among the 328 patients considered, the prevalence of PTS was 27.1%. Obesity (odds ratio [OR] 2.6 [95% confidence interval (CI) 1.5-4.7]), mild contralateral venous ectasia (OR 2.2 [95% CI 1.1-4.3]), poor International Normalized Ratio (INR) control (OR per additional 1% of time with INR < 2 during anticoagulant treatment of 1.018 [95% CI 1.003-1.034]) and the presence of residual venous obstruction on ultrasound (OR 2.1 [95% CI 1.1-3.7]) significantly increased the risk for PTS in multivariable analyses. When we restricted our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n = 244), the prevalence of PTS decreased slightly to 24.6%. Only obesity remained an independent predictor of PTS (OR 2.6 [95% CI 1.3-5.0]). Poor INR control and residual venous obstruction also increased the risk, but the results were no longer statistically significant (OR 1.017 [95% CI 0.999-1.035] and OR 1.7 [95% CI 0.9-3.3], respectively). Conclusions: After a first unprovoked proximal DVT, obese patients and patients with even mild PVI constitute a group at increased risk of developing PTS for whom particular attention should be paid with respect to PTS prevention. Careful monitoring of anticoagulant treatment may prevent PTS.

KW - Deep vein thrombosis

KW - Post-thrombotic syndrome

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KW - Venous insufficiency

KW - Venous thromboembolism

KW - Villalta scale

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