Elsevier

Thrombosis Research

Volume 101, Issue 2, 15 January 2001, Pages 23-33
Thrombosis Research

ORIGINAL ARTICLE
Post-thrombotic Syndrome After Primary Event of Deep Venous Thrombosis 10 to 20 Years Ago

https://doi.org/10.1016/S0049-3848(00)00370-4Get rights and content

Abstract

Aims: We investigated the impact of the extent of primary deep venous thrombosis (DVT) and recurrent thrombotic events in accordance to other presumed prognostic factors for long-term clinical outcome after first DVT. Patients and methods: All consecutive in-patients, who were treated following first acute DVT between January 1, 1978 and December 31, 1988 at the Department of Angiology were identified by admission lists. Localisation, extent of primary DVT, etiology and concomitant pulmonary embolism (PE) at the time of initial presentation and occurrence of post-thrombotic syndrome (PTS) at follow-up visits were assessed by chart review. The duration and quality of the compression therapy, as well as the accuracy of the oral anticoagulant (OAC) treatment were documented. Recurrence of thrombosis embolism and/or PE with respect to the intensity of OAC was analyzed. Patients were invited to participate in clinical reinvestigation. Patients' history and clinical stage of PTS were re-evaluated and patients were asked for compliance in wearing compression stockings. A survey concerning restriction in quality of life was conducted. Hemodynamic measurements by strain-gauge plethysmography (SGP) were performed. Results: One hundred and sixty-one patients were eligible for the study. Out of these 132 patients, 82% suffered from the PTS, defined as signs of chronic venous insufficiency (CVI) secondary to DVT of the lower limbs: 74 patients (46%) presented with clinical stage I after Widmer, 47 patients (29%) with clinical stage II and 11 patients (7%) with clinical stage III. No sign of PTS was seen in 29 patients (18%). The mean follow-up period of 6.6 years was statistically not different between the three severity groups of PTS. The severity of clinical symptoms was significantly associated with the recurrence of ipsilateral thrombosis (n=26/16%). Highest risk for developing severe PTS was seen after four-level DVT and deep vein thrombosis of the lower leg. Patients having had a non-sufficient OAC (Hepatoquick >25% in more than 50% of measurements) exhibited worse progradient clinical stages. Besides the high rate of bleeding complications after thrombolytic therapy, this strategy did not show more efficiency in prevention of development of severe PTS than heparin therapy alone. Conclusion: Our results show that primary four-level DVT, calf vein thrombosis, recurrence of ipsilateral DVT and a non-sufficient oral anticoagulation are of prognostic significance for developing clinically relevant PTS within 10 to 20 years after first DVT.

Section snippets

Patients

All consecutive patients who were admitted to the Department of Angiology of an Austrian tertiary care university hospital between January 1, 1978 and December 31, 1988 with a first acute DVT in the lower extremities were identified retrospectively by admission lists. We only included patients whose diagnosis of DVT was proven by phlebography and who were treated as in-patients at the department. We excluded all patients without a documented follow-up of more than 1 year after the index event.

Definitions

Demographic Data

Within the 10-year study period, 241 patients with a first acute DVT in the leg were diagnosed by phlebography and treated as in-patients at our department. Eighty patients (33%) had to be excluded from the study because data were incomplete or patients were not eligible to follow up.

Final analysis included 161 patients, who had a well-documented follow-up period for a minimum of 1 year. The median age at time of primary DVT was 55 years (IQR 43 to 65, range 16 to 86), 86 patients (53%) were

Discussion

Besides, the risk of acute PE morbidity of patients with DVT remains high even years after the event [1], [2]. In particular, PTS may restrict patients' quality of life leading ultimately to ulceration of the effected extremity [2], [3], [4], [5], [6]. Most studies concentrated on the description of the clinical course of PTS [2], [4], [5], [6], [7], [8], whereas hardly any data on hemodynamic alterations during PTS exist. Furthermore, due to different screening methods, the published results

Acknowledgements

We thank Brigitta Schönauer for the technical assistance in performing the plethysmographic studies.

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