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Long-term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS-PTS study

Authors :
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
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
Source :
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⟩
Publication Year :
2020

Abstract

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.

Details

Language :
English
ISSN :
15387836 and 15387933
Database :
OpenAIRE
Journal :
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⟩
Accession number :
edsair.doi.dedup.....30aa3a9b98f2ababd8a271febd8e76ed
Full Text :
https://doi.org/10.1111/jth.14728⟩