Engeseth Marit, Enden Tone, Sandset Per Morten, Wik Hilde Skuterud
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, N-0424, Oslo, Norway.
Thromb J. 2021 Jan 8;19(1):3. doi: 10.1186/s12959-020-00253-8.
Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT.
During 2006-09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (> 1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression.
Eighty-eight patients (52%) were included 8-10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93-0.99), and 1.23 (95% CI, 1.02-1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments.
In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.
血栓形成后综合征（PTS）是下肢近端深静脉血栓形成（DVT）常见的慢性并发症，但PTS的预测因素尚未完全明确。我们旨在研究近端DVT后长期PTS患者的PTS预测因素。
2006年至2009年期间，209例首次发生急性股上段或髂股静脉DVT的患者被随机分为两组，分别接受额外的导管定向溶栓治疗或单纯传统治疗。2017年，邀请170名仍在世的参与者参加一项横断面随访研究。由于缺乏金标准诊断试验，PTS根据临床实践通过四个强制性、预先定义的临床标准进行定义：1.客观证实的DVT；2.DVT患侧的慢性症状（>1个月）；3.症状出现在DVT之后；4.不太可能有其他诊断。通过多因素逻辑回归确定PTS的可能预测因素。
88例患者（52%）在首次DVT发生8至10年后纳入研究，44例患者（50%）根据预先定义的临床标准被诊断为PTS。发现年龄较小和基线Villalta评分较高是PTS的独立预测因素，即比值比分别为0.96（95%置信区间，0.93 - 0.99）和1.23（95%置信区间，1.02 - 1.49）。六个月随访时髂股静脉未通畅在二元分析中具有显著性，但在多因素调整后未证明具有显著性。
在近端高位DVT的长期随访中，DVT诊断时年龄较小和Villalta评分较高是PTS的独立预测因素。
