Department of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands.
Department of Internal Medicine, Maxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven, the Netherlands.
Thromb Res. 2019 May;177:102-109. doi: 10.1016/j.thromres.2019.03.003. Epub 2019 Mar 6.
The reported incidences of post-thrombotic syndrome (PTS) after deep vein thrombosis (DVT) vary. Further, PTS symptom development over time and its long-term incidence are unknown.
Patients included in the MEGA study were interviewed at 1 year and completed a questionnaire at 8 years of follow-up regarding symptoms and signs of PTS based on the Villalta score after a first DVT diagnosis. The cumulative incidence of PTS at 0-1 and 1-8 year, changes in PTS classification and the effect of possible clinical and laboratory risk factors were determined.
After 1 year, 361 out of 1657 patients diagnosed with DVT were classified as having PTS, for a 0-1 year cumulative incidence of 21.8% (95%CI 19.9-23.8), out of whom 92 (5.6%) had severe PTS. After 8 years 633 patients without previous PTS completed the second questionnaire, of whom 44 were classified as having PTS, for a 1-8 year cumulative incidence of 7% (95%CI 5.2-9.2); of these 13 (2.1%) were classified as severe PTS. During follow-up PTS complaints improved in 69% and worsened in 7% of patients. At 1 year, risk factors were female sex (RR 1.5; 95%CI 1.2-1.9) and obesity (RR 1.5; 95%CI 1.2-7.9), with the same effect sizes at 8 years. Provoked/unprovoked DVT, thrombus location, pregnancy, hormone use and several laboratory parameters did not affect risk of PTS, either at 1 or 8 years.
The incidence of PTS remained substantial up to 8 years after a first DVT. Symptoms improved in a large proportion of the cases. The short and long term risks were highest in women and obese patients.
深静脉血栓形成（DVT）后报告的血栓后综合征（PTS）发生率存在差异。此外，PTS 症状随时间的发展及其长期发生率尚不清楚。
MEGA 研究中的患者在首次 DVT 诊断后 1 年接受访谈，并在 8 年随访时根据 Villalta 评分完成关于 PTS 症状和体征的问卷。确定 PTS 在 0-1 年和 1-8 年的累积发生率、PTS 分类的变化以及可能的临床和实验室危险因素的影响。
1 年后，1657 例 DVT 患者中有 361 例被归类为 PTS，0-1 年累积发生率为 21.8%（95%CI 19.9-23.8），其中 92 例（5.6%）为严重 PTS。8 年后，633 例无先前 PTS 的患者完成了第二次问卷，其中 44 例被归类为 PTS，1-8 年的累积发生率为 7%（95%CI 5.2-9.2）；其中 13 例（2.1%）为严重 PTS。在随访期间，69%的患者 PTS 症状改善，7%的患者恶化。1 年时，危险因素为女性（RR 1.5；95%CI 1.2-1.9）和肥胖（RR 1.5；95%CI 1.2-7.9），8 年时的效应大小相同。诱发/非诱发 DVT、血栓位置、妊娠、激素使用和几个实验室参数在 1 年或 8 年时均未影响 PTS 的风险。
首次 DVT 后，PTS 的发生率在 8 年内仍保持较高水平。大多数病例的症状有所改善。女性和肥胖患者的短期和长期风险最高。
