New perspectives for prevention of the post-thrombotic syndrome
https://doi.org/10.4081/btvb.2022.20
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While on conventional anticoagulation, up to 50% of patients with one or more episodes of proximal deep vein thrombosis (DVT) can develop post-thrombotic (PTS) manifestations. The potential strategies for PTS prevention are the treatment of acute DVT with catheter-directed thrombolysis (CDT), the use of elastic compression stockings (ECS) and that of the direct oral anticoagulants (DOAC) in place of vitamin K antagonists (VKA) for the initial and long-term treatment of DVT. Based on the results of three randomized clinical trials, CDT cannot be recommended on a routine basis because of its invasiveness, the associated risk of major bleedings and the uncertainty about its efficacy. According to the results of a placebo-controlled randomized clinical trial, ECS are no longer recommended for PTS prevention on a routine basis. However, based on the results of a recent subanalysis of a prospective cohort study, patients with residual vein thrombosis and/or popliteal valve reflux at three months are likely to benefit from ECS for at least six months. Finally, following the demonstration that the inadequacy of VKA therapy plays a key role in the PTS development, several retrospective and prospective studies have shown that the use of DOACs for the initial and long-term treatment of DVT in place of VKAs reduces the risk of PTS by approximately 50%. In conclusion, the availability of DOACs and the potential of ECS in selected patients with proximal DVT are expected to play a key role for decreasing the rate and the severity of PTS in the forthcoming years.
Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation 2014;130:1636-61. DOI: https://doi.org/10.1161/CIR.0000000000000130
Visonà A, Quere I, Mazzolai L, et al. Post-thrombotic syndrome. Vasa 2021;50:331-40. DOI: https://doi.org/10.1024/0301-1526/a000946
Guanella R, Ducruet T, Johri M, et al. Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation. J Thromb Haemost 2011;9:2397-405. DOI: https://doi.org/10.1111/j.1538-7836.2011.04516.x
Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996;125:1-7. DOI: https://doi.org/10.7326/0003-4819-125-1-199607010-00001
Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008;149:698-707. DOI: https://doi.org/10.7326/0003-4819-149-10-200811180-00004
Rabinovich A, Kahn SR. The postthrombotic syndrome: current evidence and future challenges. J Thromb Haemost 2017;15:230-41. DOI: https://doi.org/10.1111/jth.13569
Rabinovich A, Cohen JM, Cushman M, et al. Inflammation markers and their trajectories after deep vein thrombosis in relation to risk of postthrombotic syndrome. J Thromb Haemost 2015;13:398-408. DOI: https://doi.org/10.1111/jth.12814
Rabinovich A, Ducruet T, Kahn SR. Development of a clinical prediction model for the postthrombotic syndrome in a prospective cohort of patients with proximal deep vein thrombosis. J Thromb Haemost 2018;16:262-70. DOI: https://doi.org/10.1111/jth.13909
Rabinovich A, Gu CS, Vedantham S, et al. External validation of the SOX-PTS score in a prospective multicenter trial
of patients with proximal deep vein thrombosis. J Thromb Haemost 2020;18:1381-9. DOI: https://doi.org/10.1111/jth.14791
Amin EE, Ten Cate-Hoek AJ, Bouman AC, et al. Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome: a cost-effectiveness analysis. Lancet Haematol 2018;5:e512-9. DOI: https://doi.org/10.1016/S2352-3026(18)30151-0
Amin EE, van Kuijk SMJ, Joore MA, et al. Development and validation of a practical two-step prediction model and clinical risk score for post-thrombotic syndrome. Thromb Haemost 2018;118:1242-9. DOI: https://doi.org/10.1055/s-0038-1655743
Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 2017;377:2240-52. DOI: https://doi.org/10.1056/NEJMoa1615066
Comerota AJ, Kearon C, Gu CS, et al. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation 2019;139:1162-73. DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.037425
Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 2012;379:31-8. DOI: https://doi.org/10.1016/S0140-6736(11)61753-4
Haig Y, Enden T, Grøtta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis
(CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol 2016;3:e64-71. DOI: https://doi.org/10.1016/S2352-3026(15)00248-3
Notten P, Ten Cate-Hoek AJ, Arnoldussen CWKP, et al. Ultrasound-accelerated catheter-directed thrombolysis versus anticoagulation for the prevention of post-thrombotic syndrome (CAVA): a single-blind, multicentre, randomised trial. Lancet Haematol 2020;7:e40-9. DOI: https://doi.org/10.1016/S2352-3026(19)30209-1
Notten P, de Smet AAEA, Tick LW, et al. CAVA (ultrasoundaccelerated catheter-directed thrombolysis on preventing post-thrombotic syndrome) trial: long-term follow-up results. J Am Heart Assoc 2021;10:e018973. DOI: https://doi.org/10.1161/JAHA.120.018973
Brandjes DP, Büller HR, Heijboer H, et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997;349:759-62. DOI: https://doi.org/10.1016/S0140-6736(96)12215-7
Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004;141:249-56. DOI: https://doi.org/10.7326/0003-4819-141-4-200408170-00004
Kahn SR, Shapiro S, Wells PS, et al. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 2014;383:880-8. DOI: https://doi.org/10.1016/S0140-6736(13)61902-9
Stevens SM, Woller SC, Baumann Kreuziger L, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report - Executive summary. Chest 2021;160:2247-59. DOI: https://doi.org/10.1016/j.chest.2021.07.056
Rabe D, Partsch H, Heidl G, et al. Compression treatment in acute symptomatic proximal deep venous thrombosis Results of a worldwide survey. Phlebology 2021;36:526-34. DOI: https://doi.org/10.1177/02683555211003801
Mol GC, van de Ree MA, Klok FA, et al. One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): randomised controlled trial. BMJ 2016;353:i2691. DOI: https://doi.org/10.1136/bmj.i2691
Subbiah R, Aggarwal V, Zhao H, et al. Effect of compression stockings on post thrombotic syndrome in patients with deep vein thrombosis: a meta-analysis of randomised controlled trials. Lancet Haematol 2016;3:e293-300. DOI: https://doi.org/10.1016/S2352-3026(16)30017-5
Dronkers CEA, Mol GC, Maraziti G, et al. Predicting postthrombotic syndrome with ultrasonographic follow-up after deep vein thrombosis: a systematic review and meta-analysis. Thromb Haemost 2018;118:1428-38. DOI: https://doi.org/10.1055/s-0038-1666859
Prandoni P, Lensing AW, Prins MH, et al. The impact of residual thrombosis on the long-term outcome of patients with deep venous thrombosis treated with conventional anticoagulation. Semin Thromb Hemost 2015;41:133-40. DOI: https://doi.org/10.1055/s-0035-1544161
Prandoni P, Lensing AW, Prins MH, et al. Elastic compression stockings for prevention of the post-thrombotic syndrome in patients with and without residual vein thrombosis and/or popliteal valve reflux. Haematologica 2022;107:303-7. DOI: https://doi.org/10.3324/haematol.2021.279680
van Dongen CJ, Prandoni P, Frulla M, et al. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost 2005;3:939-42. DOI: https://doi.org/10.1111/j.1538-7836.2005.01333.x
Hull RD, Liang J, Townshend G. Long-term low-molecular-weight heparin and the post-thrombotic syndrome: a systematic review. Am J Med 2011;124:756-65. DOI: https://doi.org/10.1016/j.amjmed.2011.02.033
Makedonov I, Kahn SR, Abdulrehman J, et al. Prevention of the postthrombotic syndrome with anticoagulation: a narrative
review. Thromb Haemost 2021 Dec 1. doi: 10.1055/a-1711-1263 [online ahead of print]. DOI: https://doi.org/10.1055/a-1711-1263
van Es N, Coppens M, Schulman S, et al. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood 2014;124:1968-75. DOI: https://doi.org/10.1182/blood-2014-04-571232
Prandoni P, Ageno W, Mumoli N, et al. Recanalization rate in patients with proximal vein thrombosis treated with the direct oral anticoagulants. Thromb Res 2017;153:97-100. DOI: https://doi.org/10.1016/j.thromres.2017.03.022
Prandoni P, Ageno W, Ciammaichella M, et al. The risk of post-thrombotic syndrome in patients with proximal deep vein thrombosis treated with the direct oral anticoagulants. Intern Emerg Med 2020;15:447-52. DOI: https://doi.org/10.1007/s11739-019-02215-z
Li R, Yuan M, Cheng J, Yu S, et al. Risk of post-thrombotic syndrome after deep vein thrombosis treated with rivaroxaban versus vitamin-K antagonists: a systematic review and meta-analysis. Thromb Res 2020;196:340-8. DOI: https://doi.org/10.1016/j.thromres.2020.09.014
Prins MH, Lensing AWA, Prandoni P, et al. Risk of recurrent venous thromboembolism according to baseline risk factor profiles. Blood Adv 2018;2:788-96. DOI: https://doi.org/10.1182/bloodadvances.2018017160
Agnelli G, Buller HR, Cohen A, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med
;368:699-708.
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