Predictors of the post-thrombotic syndrome during long-term treatment of proximal deep vein thrombosis
Authors: KAHN, S. R.; KEARON, C.1; JULIAN, J. A.1; MACKINNON, B.1; KOVACS, M. J.2; WELLS, P.3; CROWTHER, M. A.1; ANDERSON, D. R.4; VAN NGUYEN, P.5; DEMERS, C.6; SOLYMOSS, S.; KASSIS, J.5; GEERTS, W.7; RODGER, M.3; HAMBLETON, J.8; GINSBERG, J. S.1
Source: Journal of Thrombosis and Haemostasis, Volume 3, Number 4, April 2005 , pp. 718-723(6)
Publisher: Blackwell Publishing
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Abstract:
Summary. 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.Keywords: anticoagulation; deep venous thrombosis; factor V Leiden; post-thrombotic syndrome; prothrombin mutation; thrombophilia
Document Type: Research article
DOI: 10.1111/j.1538-7836.2005.01216.x
Affiliations: 1: McMaster University, Hamilton, Ontario, Canada 2: University of Western Ontario, London, Ontario, Canada 3: University of Ottawa, Ottawa, Ontario, Canada 4: Dalhousie University, Halifax, Nova Scotia, Canada 5: University of Montreal, Montreal, Quebec, Canada 6: Laval University, Quebec City, Quebec, Canada 7: University of Toronto, Toronto, Ontario, Canada 8: University of California, San Francisco, CA, USA
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