Long-term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS-PTS study
Autor: | M.-T. Barrellier, Antoine Diard, D. Brisot, David R. Morrison, D. Pontal, Helia Robert-Ebadi, Marc Philip Righini, Susan Solymoss, Jeannine Kassis, Aymeric Douillard, Myriam Martin, Sandrine Accassat, Pascale Faisse, Jean-Philippe Galanaud, Aurélien Delluc, Isabelle Quéré, Lorris Le Collen, Marc Carrier, Susan R. Kahn, Hervé Guenneguez |
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Přispěvatelé: | Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Sunnybrook Health Sciences Centre, Geneva University Hospitals and Geneva University, Lady Davis Institute for Medical Research [Montréal], McGill University = Université McGill [Montréal, Canada]-Jewish General Hospital, Département de Médécine Vasculaire [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Vascular Medicine office, Clinique Mégival, CRP Clinique du Parc, Castelnau-Le-Lez, Vascular Medicine Physician, Centre hospitalier universitaire de Saint-Etienne, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Ottawa Hospital Research Institute [Ottawa] (OHRI), McGill University Health Center [Montreal] (MUHC), Hôpital Maisonneuve-Rosemont |
Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Cactaceae
medicine.medical_specialty Popliteal Vein medicine.drug_class Chronic venous insufficiency Epidemiology Deep vein Low molecular weight heparin macromolecular substances 030204 cardiovascular system & hematology MESH: Anticoagulants Lower risk Postthrombotic Syndrome 03 medical and health sciences 0302 clinical medicine Postthrombotic syndrome [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system MESH: Risk Factors Risk Factors Deep vein thrombosis medicine otorhinolaryngologic diseases Humans cardiovascular diseases Risk factor MESH: Cactaceae Venous Thrombosis ddc:616 MESH: Humans business.industry MESH: Postthrombotic Syndrome MESH: Popliteal Vein Anticoagulant Anticoagulants [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology Hematology medicine.disease Thrombosis 3. Good health Surgery Pulmonary embolism Clinical trial medicine.anatomical_structure Nadroparin MESH: Venous Thrombosis [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie business |
Zdroj: | Journal of Thrombosis and Haemostasis, Vol. 18, No 4 (2020) pp. 857-864 Journal of Thrombosis and Haemostasis Journal of Thrombosis and Haemostasis, Wiley, 2020, 18 (4), pp.857-864. ⟨10.1111/jth.14728⟩ |
ISSN: | 1538-7836 1538-7933 |
Popis: | International audience; After a proximal lower limb deep vein thrombosis (DVT; involving popliteal veins or above), up to 40% of patients develop postthrombotic syndrome (PTS) as assessed by the Villalta scale (VS). Poor initial anticoagulant treatment is a known risk factor for PTS. The risk of developing PTS after isolated distal DVT (infra-popliteal DVT without pulmonary embolism), and the impact of anticoagulant treatment on this risk, are uncertain.Methods: Long-term follow-up of CACTUS double-blind trial comparing 6 weeks of s.c. nadroparin (171 IU/kg/d) versus s.c. placebo for a first symptomatic isolated distal DVT. At least 1 year after randomization, patients had a PTS assessment in clinic or by phone using the VS.Results: After a median follow-up of 6 years, PTS was present in 30% (n = 54) of the 178 patients who had a PTS assessment. PTS was moderate or severe in 24% (n = 13) of cases. There was no statistically significant difference in prevalence of PTS in the nadroparin versus placebo groups (29% versus 32%, P = .6), except in patients without evidence of primary chronic venous insufficiency (9% versus 24%, P = .04). Rates of venous thromboembolism recurrence during follow-up in the nadroparin and placebo groups were, respectively, 8% (n = 7) and 14% (n = 13; P = .2).Conclusion: After a first isolated distal DVT, the risk of PTS is substantial but much lower than that reported after proximal DVT. Anticoagulation with nadroparin doesn't provide any clear benefit to prevent PTS, except in patients without preexisting chronic venous insufficiency. Anticoagulation might be associated with a lower risk of venous thromboembolism recurrence. |
Databáze: | OpenAIRE |
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