Biomarkers in relation to patency, popliteal reflux and post-thrombotic syndrome

Background Despite restored patency, catheter-directed thrombolysis (CDT) has variable efficacy in preventing post-thrombotic syndrome (PTS); biomarkers may clarify PTS pathophysiology and guide patient selection for CDT. Objectives To investigate relationships between biomarkers, patency, popliteal reflux, and PTS. Methods This prespecified CAVA-trial subanalysis included patients with first acute iliofemoral deep vein thrombosis (DVT), randomized to standard treatment (ST) or ultrasound accelerated (UA)CDT. Baseline blood samples were analysed for fibrinogen, CRP, IL-6, IL-10, VEGF-A, P-selectin, E-selectin, ICAM-1, VCAM-1, MMP-2, MMP-9, and adiponectin. Patency and reflux (duplex ultrasound), and PTS (Villalta-score) were assessed at 1-year (1y) and long-term follow-up (LT). Results Among 108 patients (51 UACDT, 57 ST), absence of patency at 1y was associated with higher baseline CRP and fibrinogen in both groups, and elevated IL-6 and VEGF-A in the ST-group. Reflux at LT was associated with lower IL-6 and adiponectin in the UACDT group. (Moderate-to-severe) PTS at LT was associated with higher baseline MMP-2 and lower IL-10 in the UACDT-group, and lower baseline VCAM-1 and adiponectin in the ST-group. Conclusion Pro-inflammatory processes are linked to reduced patency, with UACDT improving patency in patients with enhanced inflammatory responses. LT-reflux is associated with impaired vasoprotective properties. PTS involves impaired anti-inflammatory responses and tissue remodelling both not modifiable by UACDT. Therefore, biomarker-guided treatment selection may potentially improve treatment outcome.

Publication History

Received: 29 August 2025

Accepted after revision: 21 January 2026

Accepted Manuscript online:
27 January 2026