Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands; Department of Internal Medicine, Meander Medical Center, Amersfoort, the Netherlands.
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Thromb Res. 2019 Jan;173:35-41. doi: 10.1016/j.thromres.2018.11.002. Epub 2018 Nov 7.
Elastic compression stockings (ECS) are uncomfortable to wear but may prevent post-thrombotic syndrome (PTS). The ability to predict PTS may help clinical decision making regarding the optimal duration of ECS after deep vein thrombosis (DVT).
Predefined endpoint analysis of the Octavia study that randomized patients who compliantly used ECS up to one year after DVT to continue or discontinue ECS treatment. Primary aim was to identify predictors of PTS.
Patient characteristics were collected and ultrasonography was performed to assess reflux, residual thrombosis and persistent thrombus load 12 months after DVT. Multivariable analyses were performed to identify factors related to PTS.
Thrombus score ≥ 3, BMI ≥ 26, duration of symptoms before DVT diagnosis ≥ 8 days and a Villalta score of 2-4 points were statistically significant predictors of PTS. The predictive value for PTS for the assessed variables was not different between the 2 treatment groups. In the stop ECS group, 3.2% (95%CI 0.08-18) of patients without any predictors for PTS were diagnosed with mild PTS during follow-up, and none with severe PTS, for a sensitivity of 98% (95% CI 89-100), a specificity of 14% (95% CI 10-20), a positive predictive value of 20% (95% CI 19-22), and a negative predictive value of 97% (95% CI 81-100).
We identified 4 predictors of PTS occurring in the 2nd year after DVT. Our findings may be used to decide on whether to continue ECS treatment for an additional year, after one year of compliant ECS use, keeping in mind that patients with none of the predictors will have the lowest PTS incidence.
弹性压缩袜（ECS）穿着不舒服，但可能预防血栓后综合征（PTS）。预测 PTS 的能力可能有助于在深静脉血栓形成（DVT）后决定 ECS 的最佳使用时间，以改善临床决策。
对奥克塔维亚研究进行预设终点分析，该研究将合规使用 ECS 长达一年的 DVT 患者随机分为继续或停止 ECS 治疗组。主要目的是确定 PTS 的预测因素。
收集患者特征，并在 DVT 后 12 个月进行超声检查以评估反流、残留血栓和持续血栓负荷。进行多变量分析以确定与 PTS 相关的因素。
血栓评分≥3、BMI≥26、DVT 诊断前症状持续时间≥8 天和 Villalta 评分为 2-4 分是 PTS 的统计学显著预测因素。评估变量对 PTS 的预测价值在两组治疗之间无差异。在停止 ECS 组中，3.2%（95%CI 0.08-18）无任何 PTS 预测因素的患者在随访期间被诊断为轻度 PTS，无严重 PTS，敏感性为 98%（95%CI 89-100），特异性为 14%（95%CI 10-20），阳性预测值为 20%（95%CI 19-22），阴性预测值为 97%（95%CI 81-100）。
我们确定了 4 个预测 DVT 后第二年 PTS 的因素。我们的发现可用于决定在遵守 ECS 治疗一年后是否继续治疗一年，同时记住没有任何预测因素的患者 PTS 发生率最低。
