Mangwani Jitendra, Roberts Veronica, Shannak Odei, Divall Pip, Srinivasan Ananth, Dias Joseph
Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
Department of Trauma and Orthopaedics, Southern Health and Social Care Trust, Belfast BT63 5QQ, UK.
J Clin Med. 2023 Sep 11;12(18):5896. doi: 10.3390/jcm12185896.
: Post-thrombotic syndrome (PTS) is a common and debilitating sequela of lower limb deep vein thrombosis (DVT). There is significant heterogeneity in reported PTS incidence due to lack of standardised diagnostic criteria. This review aimed to develop diagnostic criteria for PTS and subsequently refine the reported incidence and severity. : PRISMA principles were followed; however, the review was not registered. The Cochrane CENTRAL database, MEDLINE, Embase, the NHS NICE Healthcare Databases Advanced Search interface, and trial registers including isrctn.com and clinicaltrials.gov were searched for studies addressing areas of interest (PTS definition, epidemiology, assessment). An experienced Clinical Librarian undertook the systematic searches, and two independent reviewers agreed on the relevance of the papers. Conflicts were resolved through panel review. Evidence quality was assessed using a modified Coleman scoring system and weighted according to their relevance to the aforementioned areas of interest. : A total of 339 abstracts were retrieved. A total of 33 full-text papers were included in this review. Following qualitative analysis, four criteria were proposed to define PTS: (1) a proven thrombotic event on radiological assessment; (2) a minimum 24-month follow-up period after an index DVT; (3) assessment with a validated score; and (4) evidence of progression of venous insufficiency from baseline. Four papers conformed to our PTS definition criteria, and the incidence of mild to moderate PTS ranged from 7 to 36%. On reviewing the studies which utilised the recommended Villalta scale, PTS incidence narrowed further to 23-36%. Incidence and severity reached a plateau at 24 months. : Four diagnostic criteria were developed from qualitative synthesis. When these criteria were applied to the literature, the range of reported PTS incidence narrowed. These four criteria may standardise PTS diagnosis in future studies, facilitating the pooling of data for meta-analysis and synthesis of higher levels of evidence.
血栓形成后综合征（PTS）是下肢深静脉血栓形成（DVT）常见且使人衰弱的后遗症。由于缺乏标准化的诊断标准，报道的PTS发病率存在显著异质性。本综述旨在制定PTS的诊断标准，并随后完善报道的发病率和严重程度。遵循PRISMA原则；然而，该综述未进行注册。检索了Cochrane CENTRAL数据库、MEDLINE、Embase、英国国家医疗服务体系（NHS）优质医疗数据库高级搜索界面以及包括isrctn.com和clinicaltrials.gov在内的试验注册库，以查找涉及感兴趣领域（PTS定义、流行病学、评估）的研究。一位经验丰富的临床图书馆员进行了系统检索，两名独立评审员对论文的相关性达成一致。通过小组评审解决冲突。使用改良的科尔曼评分系统评估证据质量，并根据其与上述感兴趣领域的相关性进行加权。共检索到339篇摘要。本综述共纳入33篇全文论文。经过定性分析，提出了四项定义PTS的标准：（1）放射学评估证实有血栓形成事件；（2）首发DVT后至少24个月的随访期；（3）用经过验证的评分进行评估；（4）有静脉功能不全从基线进展的证据。有四篇论文符合我们的PTS定义标准，轻度至中度PTS的发病率为7%至36%。在审查使用推荐的维拉塔量表的研究时，PTS发病率进一步缩小至23%至36%。发病率和严重程度在24个月时达到平稳状态。通过定性综合得出了四项诊断标准。当将这些标准应用于文献时，报道的PTS发病率范围缩小。这四项标准可能会在未来研究中使PTS诊断标准化，便于汇总数据进行荟萃分析并综合更高水平的证据。
