Predictors of the post-thrombotic syndrome during long-term treatment of proximal deep vein thrombosis
S R Kahn, C Kearon, J A Julian, B Mackinnon, M J Kovacs, P Wells, M A Crowther, D R Anderson, P Van Nguyen, C Demers, S Solymoss, J Kassis, W Geerts, M Rodger, J Hambleton, J S Ginsberg, Extended Low-intensity Anticoagulation for Thrombo-embolism (ELATE) Investigators, S R Kahn, C Kearon, J A Julian, B Mackinnon, M J Kovacs, P Wells, M A Crowther, D R Anderson, P Van Nguyen, C Demers, S Solymoss, J Kassis, W Geerts, M Rodger, J Hambleton, J S Ginsberg, Extended Low-intensity Anticoagulation for Thrombo-embolism (ELATE) Investigators
Abstract
Background: The post-thrombotic syndrome is a chronic, poorly understood complication of deep venous thrombosis (DVT).
Objectives: To evaluate predictors of the post-thrombotic syndrome, including intensity of long-term anticoagulation, and to assess the impact of the post-thrombotic syndrome on quality of life.
Patients and methods: The setting was 13 Canadian hospitals and one US hospital. One hundred and forty-five patients with an unprovoked episode of proximal DVT who were initially treated with 3 months of conventional-intensity warfarin [target International Normalized Ratio (INR) of 2.5] then participated in a trial comparing two intensities of long-term warfarin therapy (target INR 2.5 vs. INR 1.7). Post-thrombotic syndrome was assessed at the end of the trial using a validated clinical scale. Generic and venous disease-specific quality of life was compared in patients with and without the post-thrombotic syndrome. Multivariable regression analyses were performed to identify predictors of the post-thrombotic syndrome and of its severity.
Results: After an average follow-up of 2.2 years, the prevalence of post-thrombotic syndrome was 37% and of severe post-thrombotic syndrome was 4%. Quality of life was worse in patients with the post-thrombotic syndrome compared with patients who did not have it. The presence of factor (F)V Leiden or the prothrombin gene mutation was an independent predictor of both a lower risk (P = 0.006) and reduced severity (P = 0.045) of the post-thrombotic syndrome. Intensity of anticoagulation did not influence the risk of developing the post-thrombotic syndrome.
Conclusions: The post-thrombotic syndrome is a frequent and burdensome complication of proximal DVT, even among patients maintained on long-term oral anticoagulation. While the presence of FV Leiden or prothrombin gene mutation appears to be associated with a reduced risk of post-thrombotic syndrome, this finding requires further evaluation in prospective studies.
Source: PubMed