Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands.
Thromb Haemost. 2018 Aug;118(8):1428-1438. doi: 10.1055/s-0038-1666859. Epub 2018 Jul 4.
Post-thrombotic syndrome (PTS) is a common and potential severe complication of deep venous thrombosis (DVT). Elastic compression stocking therapy may prevent PTS if worn on a daily basis, but stockings are cumbersome to apply and uncomfortable to wear. Hence, identification of predictors of PTS may help physicians to select patients at high risk of PTS.
This article identifies ultrasonography (US) parameters assessed during or after treatment of DVT of the leg, that predict PTS.
This is a systematic review and meta-analysis study. Databases were searched for prospective studies including consecutive patients with DVT who received standardized treatment, had an US during follow-up assessing findings consistent with vascular damage after DVT and had a follow-up period of at least 6 months for the occurrence of PTS assessed by a standardized protocol.
The literature search revealed 1,156 studies of which 1,068 were irrelevant after title and abstract screening by three independent reviewers. After full-text screening, 12 relevant studies were included, with a total of 2,684 analysed patients. Two US parameters proved to be predictive of PTS: residual vein thrombosis, for a pooled odds ratio (OR) of 2.17 (95% confidence interval [CI], 1.79-2.63) and venous reflux at the popliteal level, for a pooled OR of 1.34 (95% CI, 1.03-1.75).
The US features reflux and residual thrombosis measured at least 6 weeks after DVT predict PTS. Whether these features may be used to identify patients who may benefit from compression therapy remains to be assessed in further studies.
血栓后综合征（PTS）是深静脉血栓（DVT）的一种常见且潜在严重的并发症。如果每天穿着弹性压缩袜治疗，可能会预防 PTS，但袜子穿起来很麻烦，穿着也不舒服。因此，识别 PTS 的预测因素可能有助于医生选择 PTS 风险较高的患者。
本文旨在确定腿部 DVT 治疗期间或之后评估的超声（US）参数，以预测 PTS。
这是一项系统评价和荟萃分析研究。检索数据库，以确定前瞻性研究，包括接受标准化治疗的连续 DVT 患者，在随访期间接受 US 检查，以评估与 DVT 后血管损伤一致的发现，并且随访期至少为 6 个月，以评估 PTS 发生情况，并采用标准化方案进行评估。
文献检索显示，有 1156 项研究，其中 1068 项在经过三位独立审查员的标题和摘要筛选后被认为不相关。经过全文筛选，纳入了 12 项相关研究，共有 2684 例患者进行了分析。有两个 US 参数被证明对 PTS 具有预测价值：残留静脉血栓形成，合并优势比（OR）为 2.17（95%置信区间[CI]，1.79-2.63），以及腘静脉水平的静脉反流，合并 OR 为 1.34（95% CI，1.03-1.75）。
DVT 后至少 6 周测量的 US 特征反流和残留血栓形成可预测 PTS。这些特征是否可用于识别可能受益于压缩治疗的患者，仍需进一步研究。
