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Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency.
MedLine Citation:
PMID:  23279046     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 be the consequence of concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS. METHODS: Using data from the REVERSE multicentre 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 (OR=2.6[1.5-4.7]), mild contralateral venous ectasia (OR=2.2[1.1-4.3]), poor INR control (OR per additional 1% of time with INR<2 during anticoagulant treatment=1.018[1.003-1.034]) and presence of residual venous obstruction on ultrasound (OR=2.1[1.1-3.7]) significantly increased the risk for PTS in multivariable analyses. When restricting our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n=244), prevalence of PTS decreased slightly to 24.6%. Only obesity remained an independent predictor of PTS (OR=2.6[1.3-5.0]). Poor INR control and residual venous obstruction also increased the risk, but results were no longer statistically significant (OR=1.017[0.999-1.035] and OR=1.7[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. © 2012 International Society on Thrombosis and Haemostasis.
Authors:
J-P Galanaud; C A Holcroft; M A Rodger; M J Kovacs; M T Betancourt; P S Wells; D R Anderson; I Chagnon; G L Gal; S Solymoss; M A Crowther; A Perrier; R H White; L M Vickars; T Ramsay; S R Kahn
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-19
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  -     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2013-1-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 International Society on Thrombosis and Haemostasis.
Affiliation:
Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.
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