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Wang J, Smeath E, Lim HY, Nandurkar H, Kok HK, Ho P. Current challenges in the prevention and management of post-thrombotic syndrome-towards improved prevention. Int J Hematol 2023; 118:547-567. [PMID: 37651058 PMCID: PMC10615940 DOI: 10.1007/s12185-023-03651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Post-thrombotic syndrome (PTS) is a common and potentially debilitating complication of deep vein thrombosis (DVT), affecting up to 50% of DVT patients. The consequence of this chronic condition includes reduced quality of life, increased use of the healthcare system and decreased productivity. The societal impact of this condition is projected to increase, given our ageing population and increased burden of thrombotic diseases. Despite significant recent advances in our understanding of PTS, many unanswered questions remain. Currently, there are few effective and proven options for established PTS; hence, the emphasis should be on instituting effective prevention to reduce the progression to PTS. Effective anticoagulation lowers the risk of PTS, with direct oral anticoagulants appearing to outperform vitamin-K antagonists. However, the evidence for elastic compression stockings and endovascular thrombolysis or thrombectomy techniques remains unclear. Accurate identification of individuals at high risk of developing PTS may also improve the targeting of preventative interventions. This review will examine the current body of evidence regarding PTS, with a focus on preventative strategies as well as novel biomarkers.
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Affiliation(s)
- Julie Wang
- Northern Health, Epping, Melbourne, VIC, Australia.
- University of Melbourne, Melbourne, VIC, Australia.
- Department of Haematology, Northern Hospital, 185 Cooper St., Epping, Melbourne, 3076, VIC, Australia.
| | - Elise Smeath
- University of Melbourne, Melbourne, VIC, Australia
| | - Hui Yin Lim
- Northern Health, Epping, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | | | - Hong Kuan Kok
- Northern Health, Epping, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Prahlad Ho
- Northern Health, Epping, Melbourne, VIC, Australia
- Australian Centre for Blood Diseases, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
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2
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Wasan SM. How to Evaluate and Choose the Proper Treatments for Patients with Lower Extremity Venous Disease. Tech Vasc Interv Radiol 2023; 26:100895. [PMID: 37865448 DOI: 10.1016/j.tvir.2023.100895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
With an increasing number of interventional and noninterventional treatment options available for venous disorders, it is important that patients undergo a thorough and systematic evaluation. Clinical evaluation should include a personal and family history of venous thromboembolism (VTE), varicose veins, and thrombophilia as these factors affect response and recurrence of disease. Patient should undergo diagnostic and quality of life assessment using validated tools to monitor response to treatment. Duplex ultrasound, both deep and superficial veins, documenting both obstruction and reflux is initial imaging with CT and MRI indicated to document pelvic, iliac vein, and IVC patency and pathology. Conservative therapy including compression, healthy lifestyle with diet, and exercise. New and novel interventional therapies are available for patients with venous disease with recent randomized controlled trials and multisocietal guidelines providing evidence-based recommendations for patients with superficial and deep venous disease. Since the use of anticoagulant and antiplatelet therapies post venous intervention is not well studied nor standardized, patients should routinely undergo evaluation for ongoing risk of recurrent thrombosis and stent occlusion. Finally, patients should be counseled that superficial and deep venous disease is a chronic and often progressive disease, and follow-up at least annually is recommended.
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Affiliation(s)
- Suman M Wasan
- Department of Medicine, NC Rex Vascular Specialists, UNC Health, University of North Carolina, Chapel Hill, Raleigh, NC.
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3
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AL SAFFAR H, GHANAATI H, AL DAHHAN O, GHANEM H. First reported series of iliocaval stenting from Iraq, what are the earliest lessons. ACTA PHLEBOLOGICA 2022. [DOI: 10.23736/s1593-232x.22.00532-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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4
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Kinariwala D, Liles A, Williams DM, Khaja MS. Iliocaval Reconstruction: Review of Technique, Challenges, and Outcomes. Semin Intervent Radiol 2022; 39:464-474. [PMID: 36561935 PMCID: PMC9767777 DOI: 10.1055/s-0042-1757936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Iliocaval thrombosis is a major source of morbidity for patients, with a range of clinical presentations, including recurrent lower extremity deep venous thrombosis and postthrombotic syndrome. Endovascular reconstruction of chronic iliocaval occlusion has been demonstrated to be a technically feasible procedure that provides long-lasting symptom relief in combination with antithrombotic therapy and close clinical monitoring. Herein, we describe the etiologies of iliocaval thrombosis, patient assessment, patient management prior to and after intervention, procedural techniques, and patient outcomes.
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Affiliation(s)
- Dhara Kinariwala
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia
| | - Amber Liles
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
| | - David M. Williams
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
| | - Minhaj S. Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
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5
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Assessment of the lymphatic system by indirect lymphography in patients with post-thrombotic syndrome. J Vasc Surg Venous Lymphat Disord 2022; 10:1072-1078.e1. [PMID: 35561971 DOI: 10.1016/j.jvsv.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Alterations in lower extremity lymph drainage caused by chronic venous obstruction (CVO) have not been well studied, partially because of a lack of standardized imaging modalities to assess the quality of lymphatic drainage in the lower extremities of patients with post-thrombotic syndrome (PTS). However, these changes are likely to have an impact on the severity of the disease and clinical outcomes of interventions. In the present study, we investigated the feasibility and diagnostic value of preintervention indirect lymphography in patients with CVO and their pre- and postintervention Villalta scores. METHODS A total of 17 patients (21 limbs) with iliofemoral and caval CVO were included in the study between 2017 and 2018. The deep and superficial lymphatic vessels in both legs were assessed before venous recanalization and stenting. The quality of lymphatic flow was compared between the legs with CVO and healthy legs. Moreover, the correlation between the lymphatic changes and clinical severity of PTS was evaluated using the Villalta score and CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification. RESULTS The mean patient age was 44 ± 12 years, and 10 patients (59%) were women. The patients had undergone treatment at a mean of 25 ± 6 months after their first episode of deep vein thrombosis. Five patients (29%) had had recurrent deep vein thrombosis. The mean pre- and postinterventional Villalta score was 10.5 ± 1.46 and 9.27 ± 1.12, respectively (P = .0096). Using the CEAP classification, four legs were class 5, seven were class 4, and three each were class 3 and 2. The primary and secondary patency rate was 70.5% and 82.5% after a mean follow-up of 18 months, respectively. Indirect lymphography of the superficial and deep lymphatic systems was completed before intervention in both legs for all 17 patients (21 legs). According to the qualitative criteria, abnormal lymphatic vessel function was found in 35.2% of the superficial and 58.8% of the deep lymphatic vessels of the affected legs. Further analysis revealed abnormal function of the deep lymphatic vessels in all patients with moderate to severe PTS according to the Villalta score. CONCLUSIONS Indirect lymphography is a feasible diagnostic tool to use for the evaluation of the function of lymphatic vessels. Impaired drainage of the deep lymphatic system was found in all our patients with moderate to severe PTS. The clinical significance of these lymphatic changes is not clear; however, an association between clinical severity and outcomes is possible.
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6
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Wei WC, Hsin CH, Yang HT, Su TW, Su IH, Chu SY, Ko PJ, Yu SY, Lee CH. Clinical outcomes of AngioJet rheolytic thrombectomy in the treatment of May-Thurner syndrome-related deep venous thrombosis. J Int Med Res 2022; 50:3000605221100134. [PMID: 35650686 PMCID: PMC9168862 DOI: 10.1177/03000605221100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective May–Thurner syndrome (MTS) is an anatomic stenotic variation associated with
deep vein thrombosis (DVT) of the left leg. The classical DVT treatment
strategy is medical treatment without thrombus removal. This study was
performed to assess the clinical outcomes of the combination of AngioJet™
rheolytic thrombectomy and stenting for treatment of MTS-related DVT. Methods We conducted a retrospective cohort study of patients treated for MTS-related
DVT from January 2017 to June 2020 at a single institution. Results Fourteen patients (nine women) underwent AngioJet™ rheolytic thrombectomy for
MTS-related DVT during the study period. The median DVT onset time was 8
days (interquartile range (IQR), 3–21 days). The median procedure time was
130 minutes (IQR, 91–189 minutes), and the median hospital stay was 7 days
(IQR, 5–26 days). One patient had a residual thrombus and occluded iliac
stent and underwent adjuvant catheter-directed thrombolysis for
revascularization. The primary patency rate for the iliac stent was 92.9% at
12 months. Conclusion Concomitant AngioJet™ rheolytic thrombectomy and stenting of MTS-induced
lesions may be beneficial for patients with MTS-related DVT.
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Affiliation(s)
- Wen-Cheng Wei
- Department of Cardiovascular Surgery, Kang-Ning General Hospital, Taipei, Taiwan
| | - Chun-Hsien Hsin
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Tzu Yang
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Ta-Wei Su
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - I-Hao Su
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Yueh Yu
- Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hui Lee
- Department of Anesthesiology, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan, Taiwan
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Khaja MS, Obi AT, Sharma AM, Cuker A, McCann SS, Thukral S, Matson JT, Hofmann LV, Charalel R, Kanthi Y, Meek ME, Meissner MH, White SB, Williams DM, Vedantham S. Optimal Medical Therapy Following Deep Venous Interventions: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel. J Vasc Interv Radiol 2021; 33:78-85. [PMID: 34563699 DOI: 10.1016/j.jvir.2021.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
The optimal medical management of patients following endovascular deep venous interventions remains ill-defined. As such, the Society of Interventional Radiology Foundation (SIRF) convened a multidisciplinary group of experts in a virtual Research Consensus Panel (RCP) to develop a prioritized research agenda regarding antithrombotic therapy following deep venous interventions. The panelists presented the gaps in knowledge followed by discussion and ranking of research priorities based on clinical relevance, overall impact, and technical feasibility. The following research topics were identified as high priority: 1) characterization of biological processes leading to in-stent stenosis/rethrombosis; 2) identification and validation of methods to assess venous flow dynamics and their effect on stent failure; 3) elucidation of the role of inflammation and anti-inflammatory therapies; and 4) clinical studies to compare antithrombotic strategies and improve venous outcome assessment. Collaborative, multicenter research is necessary to answer these questions and thereby enhance the care of patients with venous disease.
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Affiliation(s)
- Minhaj S Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia.
| | - Andrea T Obi
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health, Charlottesville, Virginia
| | - Adam Cuker
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara S McCann
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia
| | - Siddhant Thukral
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - John T Matson
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia
| | - Lawrence V Hofmann
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Resmi Charalel
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Yogendra Kanthi
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary E Meek
- Division of Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David M Williams
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
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Mazzolai L, Ageno W, Alatri A, Bauersachs R, Becattini C, Brodmann M, Emmerich J, Konstantinides S, Meyer G, Middeldorp S, Monreal M, Righini M, Aboyans V. Second consensus document on diagnosis and management of acute deep vein thrombosis: updated document elaborated by the ESC Working Group on aorta and peripheral vascular diseases and the ESC Working Group on pulmonary circulation and right ventricular function. Eur J Prev Cardiol 2021; 29:1248-1263. [PMID: 34254133 DOI: 10.1093/eurjpc/zwab088] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022]
Abstract
This consensus document is proposed to clinicians to provide the whole spectrum of deep vein thrombosis management as an update to the 2017 consensus document. New data guiding clinicians in indicating extended anticoagulation, management of patients with cancer, and prevention and management of post-thrombotic syndrome are presented. More data on benefit and safety of non-vitamin K antagonists oral anticoagulants are highlighted, along with the arrival of new antidotes for severe bleeding management.
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Affiliation(s)
- Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Chemin de Mont-Paisible 18, CH-1011 Lausanne, Switzerland
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Via Ravasi 2, 21100 Varese, Italy
| | - Adriano Alatri
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Chemin de Mont-Paisible 18, CH-1011 Lausanne, Switzerland
| | - Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Grafenstraße 9, 64283 Darmstadt, Germany.,Departement of Vascular Medicine, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Cecilia Becattini
- Departement of Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Marianne Brodmann
- Département of Internal Medicine, Division of Angiology, Medical University Graz, Graz, Austria
| | - Joseph Emmerich
- Department of Vascular Medicine, Groupe Hospitalier Paris Saint-Joseph and University of Paris, Paris, France
| | - Stavros Konstantinides
- Departement of Vascular Medicine, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.,Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Saskia Middeldorp
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Marc Righini
- Division of Angiology and Hemostasis, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital and Inserm 1094, Tropical Neuroepidemiology, School of Medicine, 2 avenue martin Luther-King 87042 Limoges, France
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9
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Bosevski M, Krstevski G, Di Micco P, Fidalgo A, Loring M, Porras JA, Mellado M, Sánchez Muñoz-Torrero JF, Vela JR, Tzoran I, Monreal M. Risk for post-thrombotic syndrome after lower-limb deep vein thrombosis: location of the thrombus or residual thrombi? ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:62-72. [PMID: 34166345 DOI: 10.33529/angio2021108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many works aimed to determine factors that influence the onset of postthrombotic syndrome after an acute episode of deep venous thrombosis. We aimed to compare the prognostic value of the most proximal extent of thrombus (proximal and distal DVT) versus the residual thrombosis as identified by venous ultrasonography performed during follow-up. METHOD We conducted a retrospective study of prospectively collected 1183 consecutive cohort patients in the RIETE registry after a first episode of deep venous thrombosis and assessed for postthrombotic syndrome after 12 months. RESULTS Multivariate analysis revealed that: residual thrombosis (OR 1.40; 95% CI 0,88-2,21), the presence of cancer (OR 1.38; 95% CI: 0,64-2,97), immobility (OR 1.31; 95% CI 0,70-2,43) and estrogen-containing drugs use (OR 2.08, 95% CI 0,63-6,83), all had a predictive value for the occurrence of PTS. CONCLUSION Our study results revealed that ultrasound finding of residual thrombosis is more predictive than proximal location of thrombus for postthrombotic syndrome after episode of deep venous thrombosis. Real life data from a large group of patients from the RIETE registry substantiates that.
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Affiliation(s)
- M Bosevski
- University Cardiology Clinic, Vascular Centre, Faculty of Medicine, Skopje, R.N. Macedonia
| | - G Krstevski
- University Cardiology Clinic, Vascular Centre, Faculty of Medicine, Skopje, R.N. Macedonia
| | - P Di Micco
- Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - A Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, Spain
| | - M Loring
- Department of Internal Medicine, Hospital Comarcal de Axarquía, Málaga, Spain
| | - J A Porras
- Department of Internal Medicine, Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain
| | - M Mellado
- Department of Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain
| | | | - J R Vela
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - I Tzoran
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - M Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol Badalona, Barcelona, Universidad Autónoma de Barcelona, Barcelona, Spain
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10
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Hervé H, Toquet C, Ploton G, Connault J, Gautier G, Raimbeau A, Bergère G, Hersant J, Durant C, Artifoni M, Brebion N, Kubina JM, Pistorius MA, Espitia O. Prevalence of post-thrombotic syndrome in a cohort of upper extremity vein thrombosis. J Vasc Surg Venous Lymphat Disord 2021; 10:111-117.e3. [PMID: 33894342 DOI: 10.1016/j.jvsv.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Post-thrombotic syndrome (PTS) is one of the main complications that occurs after venous thrombosis. There are few data on the proportion of patients that will develop upper extremity PTS (UE-PTS) after upper extremity venous thrombosis (UEVT). The main objective of the study was to assess the prevalence of PTS in a UEVT cohort and to identify predictive factors of UE-PTS. METHODS This study included patients with a history of proximal or arm UEVT, diagnosed on duplex ultrasound examination, between January 1, 2015, and December 31, 2017, in a university hospital. After UEVT, each patient was evaluated by a prospective standardized recording of clinical manifestations and duplex ultrasound examination in case of upper limb symptoms. UE-PTS was defined as a modified Villalta score of 4 or higher. RESULTS Ninety-two patients were included; 68 (73.9%) had deep vein thrombosis (DVT) and 24 (19.2%) arm superficial vein thrombosis. Thirteen patients had PTS (14.1%), 12 (17.6%) in the DVT group and 1 (4.2%) in the superficial vein thrombosis group. There was a history of DVT in 92.3% of the cases of PTS. PTS was more frequent in patients with strokes with limb movement reduction (P = .01). On multivariate Cox analysis, a history of stroke (hazard ratio, 5.4; 95% confidence interval, 1.46-20.22; P = .01) was predictive of UE-PTS. CONCLUSIONS UE-PTS occurred in 14.1% of cases after UEVT. Stroke with a decrease in limb movement was a predictor of developing PTS. Diagnostic criteria should be established for UE-PTS and prospective studies are needed to improve the description and management of UE-PTS.
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Affiliation(s)
- Henri Hervé
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; Department of Vascular Medicine, CHD Vendée, La Roche sur Yon, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | | | - Gaëtan Ploton
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Jérôme Connault
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Giovanni Gautier
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Alizée Raimbeau
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Guillaume Bergère
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Jeanne Hersant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Cécile Durant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Nicolas Brebion
- Department of Vascular Medicine, CHD Vendée, La Roche sur Yon, France
| | | | - Marc-Antoine Pistorius
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France.
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11
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Cruddas L, Onida S, Davies AH. What, if anything, should replace the Villalta score for post thrombotic syndrome? Phlebology 2021; 36:595-596. [PMID: 33853453 DOI: 10.1177/02683555211008774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lucinda Cruddas
- Imperial College Healthcare NHS Trust, South Wharf Road, London, UK
| | - Sarah Onida
- Imperial College Healthcare NHS Trust, South Wharf Road, London, UK
| | - Alun H Davies
- Imperial College Healthcare NHS Trust, South Wharf Road, London, UK
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12
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Abstract
Post-thrombotic syndrome (PTS) is a chronic venous insufficiency manifestation following an episode of deep-vein thrombosis (DVT). It is an important and frequent long-term adverse event of proximal DVT affecting 20-50% of patients. This position paper integrates data guiding clinicians in deciding PTS diagnosis, treatment and follow-up.
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Affiliation(s)
- Adriana Visonà
- Angiology Unit, Azienda ULSS 2 Marca Trevigiana, Castelfranco Veneto, Italy
| | - Isabelle Quere
- Médecine Vasculaire, Université de Montpellier, Montpellier, France
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Maria Amitrano
- Internal Medicine Unit, Moscati Hospital, Avellino, Italy
| | - Marzia Lugli
- Department of Vascular Surgery, International Center of Deep Venous Surgery, Hesperia Hospital, Modena, Italy
| | - Juraj Madaric
- Clinic of Angiology, Comenius University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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13
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Smith J, Thornhill D, Goldenberg NA, Brandão L, Knapp-Clevenger R, Warren BB, Sung L, Kahn SR, Manco-Johnson M. Validation of Outcome Instruments for Pediatric Postthrombotic Syndrome: Introducing the Peds-VEINES-QOL, a New Health-Related Quality of Life Instrument. Thromb Haemost 2021; 121:1367-1375. [PMID: 33706398 DOI: 10.1055/s-0041-1725199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is need for validated outcome measures for postthrombotic syndrome (PTS) following pediatric venous thromboembolism (VTE), with a focus on quality of life (QoL). AIMS This article assesses reliability and validity of two PTS and two QoL scales for children following lower extremity VTE. METHODS Pediatric patients following lower extremity VTE were recruited from three thrombosis clinics. The Manco-Johnson (MJ) and the modified Villalta (MV) PTS scales were compared with each other and with the generic pediatric health-related QoL, PedsQL, and a newly developed pediatric venous-specific QoL, the Peds-VEINES-QOL. RESULTS Eighty children following VTE and 60 healthy control children were enrolled. Internal consistency measured by Cronbach's α was high for the two QoL scales, and moderate for the two PTS scales. Inter-rater reliability using intraclass correlation coefficients was moderate to high for the MJ, MV, and Peds-VEINES-QOL, and moderate for the PedsQL. Evidence of high internal consistency by Cronbach's α coefficients, and moderate to high interitem correlations support the premise that a single construct was measured by each instrument. Correlations between the four instruments indicate convergent validity. CONCLUSION The MJ and MV scales detect similar outcomes in children following VTE. As used, the MJ is slightly more sensitive to QoL because a positive diagnosis requires pain which is the leading factor in reduced QoL following deep vein thrombosis. When using the MV, a requirement for pain or abnormal use to diagnose PTS would make the MV a better predictor of QoL.
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Affiliation(s)
- Julie Smith
- Hemophilia and Thrombosis Center, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Dianne Thornhill
- Hemophilia and Thrombosis Center, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Neil A Goldenberg
- Department of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, United States
| | - Leonardo Brandão
- The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Canada
| | - Rhonda Knapp-Clevenger
- University of Rochester Medical Center, School of Nursing, University of Rochester, Rochester, New York, United States
| | - Beth Boulden Warren
- Hemophilia and Thrombosis Center, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Lillian Sung
- The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Canada.,Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Susan R Kahn
- Department of Medicine, Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Marilyn Manco-Johnson
- Hemophilia and Thrombosis Center, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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14
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Morris RI, Pouncey AL, Quintana B, Khan T, Smith A, Saha P, Black SA. Quality of life outcomes for patients undergoing venous stenting for chronic deep venous disease. J Vasc Surg Venous Lymphat Disord 2021; 9:1185-1192.e2. [PMID: 33540137 DOI: 10.1016/j.jvsv.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate change in venous disease-specific quality of life (QoL) after iliac vein stenting for chronic venous outflow obstruction. METHODS We performed a retrospective analysis of all Venous Insufficiency Epidemiological and Economic Study - Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaires completed at a single-center between 2016 and 2019 by patients treated with iliac vein stenting for chronic venous outflow obstruction. Patients were asked to complete the questionnaire at baseline (before stenting) and at subsequent follow-up appointments (after stenting), at 6, 12, 24, and 36 months. The Villalta score was recorded by a venous nurse specialist. The initial unpaired analysis compared all completed VEINES-QoL/Sym and Villalta scores at baseline to all follow-up time-points, and then compared them individually between baseline and each follow-up point. A secondary paired analysis included data only from patients who had completed the questionnaire at baseline and at least one follow-up. RESULTS A total of 385 questionnaires from 187 patients who completed the VEINES-QoL/Sym between 2016 and 2019 were included. The median follow-up was 12 months, 127 patients (68%) were female, and 148 (79%) were treated for post-thrombotic syndrome. The median VEINES-QoL score at baseline was 35.69 (interquartile range [IQR], 20.85-46.67). Significant improvement was observed postoperatively and sustained throughout the study period (6 months, 64.81 [IQR, 38.12-83.88]; 12 months, 60.52 [IQR, 33.6-82.3]; 24 months, 60.37 [IQR, 34.31-80.65]; 36 months, 55.98 [IQR, 39.18-81.47]). The VEINES-Sym scores demonstrated similar improvement. A secondary analysis of paired baseline/follow-up data from 61 patients confirmed significant improvement from baseline for VEINES-QoL (6 months +26.45; 12 months, +25.81; 24 months, +30.09; P ≤ .0001), VEINES-Sym (6 months, +23.86; 12 months, +20.43; 24 months, +27.55; P > .001), and Villalta scores (6 months, -3.7; 12 months, -4.2; 24 months, -6.4; P < .0001). The median Villalta score was 14 (IQR, 10-16). This score improved to 9 (IQR, 5-13) at 6 months of follow-up; to 8 (IQR, 5-11) at 12 months; to 7 (IQR, 4-12) at 24 months; and to 6 (IQR, 3.75-10.25) at 36 months (P ≤ .0001). Good correlation between the Villalta and both VEINES-QoL and SYM scores was observed at follow-up (r = 0.69 and r = 0.71, respectively; P < .0001). CONCLUSIONS Venous disease-specific QoL improves and severity of post-thrombotic syndrome is decreased after iliac vein stenting for chronic venous outflow obstruction. These improvements are sustained at 36-month follow-up.
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Affiliation(s)
- Rachael I Morris
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Anna L Pouncey
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - Belen Quintana
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - Taha Khan
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - Alberto Smith
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Prakash Saha
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Stephen A Black
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
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15
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Abstract
Postthrombotic syndrome (PTS) remains one of the major late complications of deep vein thrombosis (DVT) with a reported prevalence from 10 to 50%. Many factors were found to be related with the development and severity of PTS such as ipsilateral recurrent DVT, advanced age, obesity, ilio-femoral DVT and primary chronic venous disease presence. Some PTS prediction models have been proposed based on risk factor weight. However, it is still difficult to predict which patient with DVT will develop PTS and thus, the clinical application of these models remains limited. Among the identified problems the heterogeneity of the DVT patient population together with the variety of PTS clinical presentations and difficulties concerning PTS severity assessment should be mentioned. Difficulties on the implementation of the specific and objective PTS identification method have also the significant influence on the research focusing on PTS prevention modalities including risk factor modification, compression treatment, anticoagulation and invasive DVT treatment. In this review, the current approach and knowledge on PTS prediction and prevention are presented, including the conservative and invasive DVT treatment possibilities.
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Affiliation(s)
- Tomasz Urbanek
- Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook University School of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
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16
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Gwozdz AM, Black SA, Hunt BJ, Lim CS. Post-thrombotic Syndrome: Preventative and Risk Reduction Strategies Following Deep Vein Thrombosis. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2020.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Venous disease is common in the general population, with chronic venous disorders affecting 50–85% of the western population and consuming 2–3% of healthcare funding. It, therefore, represents a significant socioeconomic, physical and psychological burden. Acute deep vein thrombosis, although a well-recognised cause of death through pulmonary embolism, can more commonly lead to post-thrombotic syndrome (PTS). This article summarises the pathophysiology and risk factor profile of PTS, and highlights various strategies that may reduce the risk of PTS, and the endovenous management of iliofemoral deep vein thrombosis. The authors summarise the advances in PTS risk reduction strategies and present the latest evidence for discussion.
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Affiliation(s)
- Adam M Gwozdz
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, Guy’s and St Thomas’ NHS Trust, King’s College London, London, UK
| | - Stephen A Black
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, Guy’s and St Thomas’ NHS Trust, King’s College London, London, UK
| | - Beverley J Hunt
- Thrombosis and Haemostasis Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Chung S Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
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17
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Galanaud JP, Ducruet T, Kahn SR. Accuracy of contralateral Villalta score to assess for pre-existing chronic venous insufficiency in patients with unilateral deep vein thrombosis. J Thromb Haemost 2020; 18:3309-3315. [PMID: 32898930 DOI: 10.1111/jth.15091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/13/2020] [Accepted: 08/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND International guidelines recommend using the Villalta score (VS) to diagnose the postthrombotic syndrome (PTS). However, a high proportion of PTS detected with VS could just reflect the presence of preexisting primary venous insufficiency (PVI). Furthermore, it is unclear whether the contralateral VS (cl-VS) can be used to assess for preexisting PVI. OBJECTIVES To estimate whether cl-VS can be used to assess for preexisting PVI, and to assess the proportion of PTS that could be attributable to preexisting PVI. METHODS Subanalysis of the SOX multicenter randomized trial focusing on patients with a first unilateral proximal deep vein thrombosis (DVT) followed for up to 2 years. PVI was defined as a baseline cl-VS > 4, and PTS as VS > 4 in the leg ipsilateral to DVT starting 6 months after DVT. RESULTS Among 680 patients, mean cl-VS remained stable over time: 1.23 (standard deviation [SD] ±2.49) at baseline and 1.17 (±2.20), 1.59 (±2.81), 1.54 (±2.50), 1.65 (±2.82), and 1.55 (±2.63) at the 1-, 6-, 12-, 18-, and 24-month visits, respectively. Baseline cl-VS and ipsilateral VS measured during follow-up were mildly correlated (Pearson correlation = 0.13-0.25). This association disappeared after subtracting the cl-VS measured at the same visit from the ipsilateral VS. Overall, 48.8% of patients developed PTS of whom 12.8% had baseline cl-VS > 4. CONCLUSION In our study of patients with a first unilateral proximal DVT, the proportion of patients with PTS who had a cl-VS > 4 is modest. However, cl-VS appears to be stable over time. Its assessment could constitute a simple way of documenting preexisting PVI and help to classify patients as having PTS.
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Affiliation(s)
- Jean-Philippe Galanaud
- Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
| | - Thierry Ducruet
- URCA-CHU Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - Susan R Kahn
- Department of Medicine and Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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18
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Li R, Yuan M, Cheng J, Yu S, Wei W, Fu W, Prandoni P, Chen Y. Risk of post-thrombotic syndrome after deep vein thrombosis treated with rivaroxaban versus vitamin-K antagonists: A systematic review and meta-analysis. Thromb Res 2020; 196:340-348. [DOI: 10.1016/j.thromres.2020.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/27/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
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19
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Boon GJAM, Barco S, Bertoletti L, Ghanima W, Huisman MV, Kahn SR, Noble S, Prandoni P, Rosovsky RP, Sista AK, Siegerink B, Klok FA. Measuring functional limitations after venous thromboembolism: Optimization of the Post-VTE Functional Status (PVFS) Scale. Thromb Res 2020; 190:45-51. [PMID: 32298840 DOI: 10.1016/j.thromres.2020.03.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION We recently proposed a scale for assessment of patient-relevant functional limitations following an episode of venous thromboembolism (VTE). Further development of this post-VTE functional status (PVFS) scale is still needed. METHODS Guided by the input of VTE experts and patients, we refined the PVFS scale and its accompanying manual, and attempted to acquire broad consensus on its use. RESULTS A Delphi analysis was performed involving 53 international VTE experts with diverse scientific and clinical backgrounds. In this process, the number of scale grades of the originally proposed PVFS scale was reduced and descriptions of the grades were improved. After these changes, a consensus was reached on the number/definitions of the grades, and method/timing of the scale assessment. The relevance and potential impact of the scale was confirmed in three focus groups totaling 18 VTE patients, who suggested additional changes to the manual, but not to the scale itself. Using the improved manual, the κ-statistics between PVFS scale self-reporting and its assessment via the structured interview was 0.75 (95%CI 0.58-1.0), and 1.0 (95%CI 0.83-1.0) between independent raters of the recorded interview of 16 focus groups members. CONCLUSION We improved the PVFS scale and demonstrated broad consensus on its relevance, optimal grades, and methods of assessing among international VTE experts and patients. The interobserver agreement of scale grade assignment was shown to be good-to-excellent. The PVFS scale may become an important outcome measure of functional impairment for quality of patient care and in future VTE trials.
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Affiliation(s)
- G J A M Boon
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - S Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany; Clinic of Angiology, University Hospital of Zurich, Zurich, Switzerland
| | - L Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Étienne, Saint-Étienne, France; INSERM UMR 1059 and CIC 1408, Université Jean-Monnet, Saint-Étienne, France
| | - W Ghanima
- Department of Oncology, Østfold Hospital Trust, Kalnes, Norway; Department Medicine and Research, Østfold Hospital Trust, Kalnes, Norway
| | - M V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - S R Kahn
- Division of Clinical Epidemiology, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - S Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - P Prandoni
- Arianna Foundation on Anticoagulation, Bologna, Italy
| | - R P Rosovsky
- Department of Medicine, Hematology/Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - A K Sista
- Department of Radiology, New York University School of Medicine, New York, NY, United States
| | - B Siegerink
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - F A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany.
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20
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Prevention and Management of the Post-Thrombotic Syndrome. J Clin Med 2020; 9:jcm9040923. [PMID: 32230912 PMCID: PMC7230648 DOI: 10.3390/jcm9040923] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022] Open
Abstract
The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency secondary to prior deep vein thrombosis (DVT). It affects up to 50% of patients after proximal DVT. There is no effective treatment of established PTS and its management lies in its prevention after DVT. Optimal anticoagulation is key for PTS prevention. Among anticoagulants, low-molecular-weight heparins have anti-inflammatory properties, and have a particularly attractive profile. Elastic compression stockings (ECS) may be helpful for treating acute DVT symptoms but their benefits for PTS prevention are debated. Catheter-directed techniques reduce acute DVT symptoms and might reduce the risk of moderate-severe PTS in the long term in patients with ilio-femoral DVT at low risk of bleeding. Statins may decrease the risk of PTS, but current evidence is lacking. Treatment of PTS is based on the use of ECS and lifestyle measures such as leg elevation, weight loss and exercise. Venoactive medications may be helpful and research is ongoing. Interventional techniques to treat PTS should be reserved for highly selected patients with chronic iliac obstruction or greater saphenous vein reflux, but have not yet been assessed by robust clinical trials.
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21
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Ferreira T, Huber SC, de Moraes Martinelli B, Junior AL, Menezes FH, Orsi FA, Bittar LF, de Oliveira LFG, Sodre LR, Mello TT, Rielli G, Colella MP, de Paula EV, Yamaguti-Hayakawa GG, Montalvão S, Annichino-Bizzacchi JM. Low prevalence of Post-thrombotic syndrome in patients treated with rivaroxaban. Vascul Pharmacol 2020; 124:106608. [DOI: 10.1016/j.vph.2019.106608] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022]
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22
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Klok FA, Barco S, Siegerink B. Measuring functional limitations after venous thromboembolism: A call to action. Thromb Res 2019; 178:59-62. [PMID: 30980999 DOI: 10.1016/j.thromres.2019.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 12/27/2022]
Abstract
The main objectives of therapeutic trials in venous thromboembolism (VTE) are to prevent recurrent VTE, major bleeding and death. While these outcomes are indeed highly relevant, they are also rare and do not fully capture the overall functional outcome of VTE patients. Importantly, functional limitations after VTE are prevalent after both deep vein thrombosis and pulmonary embolism occurring in up to 50% of patients. These post-VTE syndromes are associated with a decreased quality of life, higher risk of depressive disorders, unemployment and increased utilization of healthcare resources. Because of the major impact of functional limitations on individual patients and society as a whole, development of tools able to capture functional outcomes in clinical trials are urgently needed. We anticipate that a standardized post-VTE functional status scale will aid in demarcating effective and ineffective VTE therapies on functional outcomes in trials with appropriately powered sample sizes, as well as pave the road for value-based healthcare. The scale that we have in mind covers the entire spectrum of functional outcomes ranging from no symptoms to death. Moreover, it focuses on both limitations in usual activity as well as changes in lifestyle. The scale is not meant to replace current diagnostic or prognostic scores for post-VTE syndromes, but to be used as an outcome measure to evaluate the overall consequences of VTE on functional status. This review is a call for action to the VTE community to join forces and support further development of the proposed scale, a process of which we summarize the necessary steps.
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Affiliation(s)
- Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
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