[Prospective 12-year follow-up study of clinical and hemodynamic sequelae of deep venous thromboses in patients with low risk (Zurich Study)].
No prospective study of the long-term sequelae of more than 10 years after acute deep vein thrombosis exists so far. Therefore, 28 patients with DVT were included in a prospective study to evaluate the natural history of postthrombotic syndrome. Clinical and hemodynamic examinations were performed at the time of admission; after 3, 6 and 12 months; after the 2nd, 3rd, 4th, 5th; and finally after the 12th year. All patients received unfractionated heparin initially and oral anticoagulants subsequently. After 12 years, 64% of the patients exhibited normal findings. Mild skin changes were found in 28%, marked trophic changes in 5%, and only 1 venous ulcer occurred. Regular use of compression stockings was reported by 54% of the patients with multilevel disease. Although mean maximum venous outflow was significantly reduced from the acute event to 2 years later (p < 0.003) compared with the contralateral leg, a significant (p < 0.05) improvement was observed 6 months later. Recanalization of calf vein thrombosis was detected by Doppler sonography after 3 months. 64% of the multilevel thromboses were recanalized completely or in part after 1 year; in 69%, valvular incompetence was found. In conclusion, in contrast to earlier reports, this prospective study up to 12 years after DVT demonstrates a low incidence of PTS by administration of initially unfractionated heparin, oral anticoagulation and compression therapy. However, the adverse clinical event rate (mortality 14%) and recurrency rate of 24% show that the prognosis after DVT does not appear favorable even in low-risk patients.
Franzeck
U K
UK
Abteilung für Angiologie, Universitäts-spitals Zürich, Schweiz. ukfranzeck@angiology.ch
Schalch
I
I
Jäger
K A
KA
Grimm
E S
ES
Bollinger
A
A
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001458:Bandages; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011186:Postphlebitic Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D013557:Switzerland; D013924:Thrombophlebitis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D000925:Anticoagulants; D006493:Heparin
Prospektive 12-Jahres-Verlaufsstudie über klinische und hämodynamische Folgen tiefer Venenthrombosen bei Patienten mit niedrigem Risiko (Zürich-Studie).