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
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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