Document Detail

Relation between D-dimer level, venous valvular reflux and the development of post-thrombotic syndrome after deep vein thrombosis.
MedLine Citation:
PMID:  20670369     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The pathophysiology of post-thrombotic syndrome (PTS) is postulated to involve persistent venous obstruction and venous valvular reflux.
OBJECTIVE: To study the association between D-dimer level, valvular reflux and the PTS in a well-defined cohort of deep vein thrombosis (DVT) patients.
METHODS: Consecutive patients with acute symptomatic DVT were recruited at eight centers and were followed for 24months. D-dimer was measured at 4months. A standardized ultrasound assessment for popliteal valvular reflux was performed at 12months. Using the Villalta scale, patients were assessed for PTS during follow-up by evaluators who were unaware of D-dimer or reflux results.
RESULTS: Three hundred and eighty-seven patients were recruited; of these, 305 provided blood samples for D-dimer and 233 had a 12-month reflux assessment. PTS developed in 45.1% of subjects. Mean D-dimer was significantly higher in patients with vs. without PTS (712.0 vs. 444.0μgL(-1) ; P=0.02). In logistic regression analyses adjusted for warfarin use at the time of D-dimer determination and risk factors for PTS, D-dimer level significantly predicted PTS (P=0.03); when stratifying for warfarin use at the time of blood draw, adjusted odds ratio (OR) for developing PTS per unit difference in log D-dimer was 2.33 (95% CI 0.89, 6.10) in those not on warfarin vs. 1.25 (95% CI 0.87, 1.79) in those on warfarin. Ipsilateral reflux was more frequent in patients with moderate-to-severe PTS than in patients with mild PTS (65% vs. 40%, respectively; P=0.01) and was independently associated with moderate-to-severe PTS in logistic regression analyses (P=0.01).
CONCLUSION: D-dimer levels, measured 4months after DVT in patients not on warfarin, are associated with subsequent development of PTS. Venous valvular reflux is associated with moderate-to-severe PTS.
J Latella; S Desmarais; M-J Miron; A Roussin; F Joyal; J Kassis; S Solymoss; L Desjardins; J S Ginsberg; S R Kahn
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  8     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-28     Completed Date:  2011-03-07     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  2169-75     Citation Subset:  IM    
Copyright Information:
© 2010 International Society on Thrombosis and Haemostasis.
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MeSH Terms
Aged, 80 and over
Cohort Studies
Fibrin Fibrinogen Degradation Products / biosynthesis*
Middle Aged
Odds Ratio
Postthrombotic Syndrome / blood*,  complications
Prospective Studies
Risk Factors
Venous Insufficiency / blood*,  complications*
Venous Thrombosis / blood*,  complications
Reg. No./Substance:
0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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