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DOI: 10.1055/s-0038-1666859
Predicting Post-Thrombotic Syndrome with Ultrasonographic Follow-Up after Deep Vein Thrombosis: A Systematic Review and Meta-Analysis
Publication History
18 September 2018
17 May 2018
Publication Date:
04 July 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/201808/lookinside/thumbnails/10-1055-s-0038-1666859_170643-1.jpg)
Abstract
Background Post-thrombotic syndrome (PTS) is a common and potential severe complication of deep venous thrombosis (DVT). Elastic compression stocking therapy may prevent PTS if worn on a daily basis, but stockings are cumbersome to apply and uncomfortable to wear. Hence, identification of predictors of PTS may help physicians to select patients at high risk of PTS.
Aims This article identifies ultrasonography (US) parameters assessed during or after treatment of DVT of the leg, that predict PTS.
Methods This is a systematic review and meta-analysis study. Databases were searched for prospective studies including consecutive patients with DVT who received standardized treatment, had an US during follow-up assessing findings consistent with vascular damage after DVT and had a follow-up period of at least 6 months for the occurrence of PTS assessed by a standardized protocol.
Results The literature search revealed 1,156 studies of which 1,068 were irrelevant after title and abstract screening by three independent reviewers. After full-text screening, 12 relevant studies were included, with a total of 2,684 analysed patients. Two US parameters proved to be predictive of PTS: residual vein thrombosis, for a pooled odds ratio (OR) of 2.17 (95% confidence interval [CI], 1.79–2.63) and venous reflux at the popliteal level, for a pooled OR of 1.34 (95% CI, 1.03–1.75).
Conclusion The US features reflux and residual thrombosis measured at least 6 weeks after DVT predict PTS. Whether these features may be used to identify patients who may benefit from compression therapy remains to be assessed in further studies.
Authors' Contributions
All authors designed the study and approve the final publication. C.E.A. Dronkers, G.C. Mol and G. Maraziti performed the literature search, study selection and data extraction. C.E.A. Dronkers and F.A. Klok performed the analysis and drafted the paper. G.C. Mol, M.A. van de Ree, M.V. Huisman and C. Becattini critically revised the paper for important intellectual content.
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References
- 1 Galanaud JP, Monreal M, Kahn SR. Predictors of the post-thrombotic syndrome and their effect on the therapeutic management of deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2016; 4 (04) 531-534
- 2 Kahn SR, Shrier I, Julian JA. , et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008; 149 (10) 698-707
- 3 Rabinovich A, Kahn SR. The postthrombotic syndrome: current evidence and future challenges. J Thromb Haemost 2017; 15 (02) 230-241
- 4 Wik HS, Ghanima W, Sandset PM, Kahn SR. Scoring systems for postthrombotic syndrome. Semin Thromb Hemost 2017; 43 (05) 500-504
- 5 Kahn SR, Partsch H, Vedantham S, Prandoni P, Kearon C. ; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost 2009; 7 (05) 879-883
- 6 Eklöf B, Rutherford RB, Bergan JJ. , et al; American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40 (06) 1248-1252
- 7 Porter JM, Moneta GL. ; International Consensus Committee on Chronic Venous Disease. Reporting standards in venous disease: an update. J Vasc Surg 1995; 21 (04) 635-645
- 8 Kurstjens RL, de Wolf MA, Konijn HW. , et al. Intravenous pressure changes in patients with postthrombotic deep venous obstruction: results using a treadmill stress test. J Thromb Haemost 2016; 14 (06) 1163-1170
- 9 Meissner MH, Zierler BK, Bergelin RO, Chandler WL, Strandness Jr DE. Coagulation, fibrinolysis, and recanalization after acute deep venous thrombosis. J Vasc Surg 2002; 35 (02) 278-285
- 10 Brandjes DP, Büller HR, Heijboer H. , et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349 (9054): 759-762
- 11 Prandoni P, Lensing AW, Prins MH. , et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004; 141 (04) 249-256
- 12 Mol GC, van de Ree MA, Klok FA. , et al. One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): randomised controlled trial. BMJ 2016; 353: i2691
- 13 Kahn SR, Shapiro S, Wells PS. , et al; SOX trial investigators. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 2014; 383 (9920): 880-888
- 14 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151 (04) 264-269
- 15 Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med 2013; 158 (04) 280-286
- 16 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
- 17 Mol GC. Pre-defined endpoint analysis Octavia study. Can ultrasonographic and laboratory measurements one year after proximal deep vein thrombosis predict posttrombotic syndrome?. Abstract number ISTH 2017 PB1002 (Unpublished data)
- 18 Haig Y, Enden T, Slagsvold C-E, Sandvik L, Sandset PM, Kløw NE. Residual rates of reflux and obstruction and their correlation to post-thrombotic syndrome in a randomized study on catheter-directed thrombolysis for deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2014; 2 (02) 123-130
- 19 Latella J, Desmarais S, Miron MJ. , et al. Relation between D-dimer level, venous valvular reflux and the development of post-thrombotic syndrome after deep vein thrombosis. J Thromb Haemost 2010; 8 (10) 2169-2175
- 20 Prandoni P, Lensing AW, Prins MH. , et al. The impact of residual thrombosis on the long-term outcome of patients with deep venous thrombosis treated with conventional anticoagulation. Semin Thromb Hemost 2015; 41 (02) 133-140
- 21 Roberts LN, Patel RK, Goss DE, Chitongo P, Bonner L, Arya R. Relationship between development of post-thrombotic syndrome and serial ultrasound, D-dimer, and factor VIII activity after a first deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2016; 4 (01) 28-35
- 22 Roumen-Klappe EM, den Heijer M, Janssen MC, van der Vleuten C, Thien T, Wollersheim H. The post-thrombotic syndrome: incidence and prognostic value of non-invasive venous examinations in a six-year follow-up study. Thromb Haemost 2005; 94 (04) 825-830
- 23 Sartori M, Favaretto E, Cini M, Legnani C, Palareti G, Cosmi B. D-dimer, FVIII and thrombotic burden in the acute phase of deep vein thrombosis in relation to the risk of post-thrombotic syndrome. Thromb Res 2014; 134 (02) 320-325
- 24 Ten Cate-Hoek AJ, Ten Cate H, Tordoir J, Hamulyák K, Prins MH. Individually tailored duration of elastic compression therapy in relation to incidence of the postthrombotic syndrome. J Vasc Surg 2010; 52 (01) 132-138
- 25 Tick LW, Doggen CJ, Rosendaal FR. , et al. Predictors of the post-thrombotic syndrome with non-invasive venous examinations in patients 6 weeks after a first episode of deep vein thrombosis. J Thromb Haemost 2010; 8 (12) 2685-2692
- 26 Vedovetto V, Dalla Valle F, Milan M, Pesavento R, Prandoni P. Residual vein thrombosis and trans-popliteal reflux in patients with and without the post-thrombotic syndrome. Thromb Haemost 2013; 110 (04) 854-855
- 27 Yamaki T, Hamahata A, Soejima K, Kono T, Nozaki M, Sakurai H. Factors predicting development of post-thrombotic syndrome in patients with a first episode of deep vein thrombosis: preliminary report. Eur J Vasc Endovasc Surg 2011; 41 (01) 126-133
- 28 Yamaki T, Hasegawa Y, Osada A. , et al. Time taken to the maximum increase in the oxygenated hemoglobin level in calf muscle as a predictor of mild and moderate post-thrombotic syndrome. J Vasc Surg Venous Lymphat Disord 2016; 4 (04) 446-454
- 29 Roumen-Klappe EM, den Heijer M, van Uum SH, van der Ven-Jongekrijg J, van der Graaf F, Wollersheim H. Inflammatory response in the acute phase of deep vein thrombosis. J Vasc Surg 2002; 35 (04) 701-706
- 30 Kahn SR, Ginsberg JS. Relationship between deep venous thrombosis and the postthrombotic syndrome. Arch Intern Med 2004; 164 (01) 17-26
- 31 Rabinovich A, Kahn SR. Development of a clinical prediction model for the post-thrombotic syndrome in a prospective cohort of patients with proximal DVT: The SOX-PTS Index, congress abstract. ISTH 2017; 2017. Abstract number: OC 60.4
- 32 Amin SMJvK E, Joore MA, ten Cate H, ten Cate-Hoek AJ. Development and validation of a practical two-step prediction model for post-thrombotic syndrome, congress abstract. ISTH 2017; 2017. Abstract number: OC 60.3
- 33 Villalta SBP, Piccioli A, Lensing A, Prins M, Prandoni P. Assessment of validity and reproducibility of a clinical scale for the post-thrombotic syndrome. (abstract) Haemostasis 1994;24(158a)