title: Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency.
abstract: BACKGROUND
  Post-thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). Its diagnosis is based on clinical characteristics. However, symptoms and signs of PTS are non-specific, and could result from concomitant primary venous insufficiency (PVI) rather than DVT. This could bias evaluation of PTS.
  
  
  METHODS
  Using data from the REVERSE multicenter study, we assessed risk factors for PTS in patients with a first unprovoked unilateral proximal DVT 5-7 months earlier who were free of clinically significant PVI (defined as absence of moderate or severe venous ectasia in the contralateral leg).
  
  
  RESULTS
  Among the 328 patients considered, the prevalence of PTS was 27.1%. Obesity (odds ratio [OR] 2.6 [95% confidence interval (CI) 1.5-4.7]), mild contralateral venous ectasia (OR 2.2 [95% CI 1.1-4.3]), poor International Normalized Ratio (INR) control (OR per additional 1% of time with INR < 2 during anticoagulant treatment of 1.018 [95% CI 1.003-1.034]) and the presence of residual venous obstruction on ultrasound (OR 2.1 [95% CI 1.1-3.7]) significantly increased the risk for PTS in multivariable analyses. When we restricted our analysis to patients without any signs, even mild, of contralateral venous insufficiency (n = 244), the prevalence of PTS decreased slightly to 24.6%. Only obesity remained an independent predictor of PTS (OR 2.6 [95% CI 1.3-5.0]). Poor INR control and residual venous obstruction also increased the risk, but the results were no longer statistically significant (OR 1.017 [95% CI 0.999-1.035] and OR 1.7 [95% CI 0.9-3.3], respectively).
  
  
  CONCLUSIONS
  After a first unprovoked proximal DVT, obese patients and patients with even mild PVI constitute a group at increased risk of developing PTS for whom particular attention should be paid with respect to PTS prevention. Careful monitoring of anticoagulant treatment may prevent PTS.
authors.affiliation: Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: J P
authors.initials: JP
authors.lastname: Galanaud
authors.forename: C A
authors.initials: CA
authors.lastname: Holcroft
authors.forename: M A
authors.initials: MA
authors.lastname: Rodger
authors.forename: M J
authors.initials: MJ
authors.lastname: Kovacs
authors.forename: M T
authors.initials: MT
authors.lastname: Betancourt
authors.forename: P S
authors.initials: PS
authors.lastname: Wells
authors.forename: D R
authors.initials: DR
authors.lastname: Anderson
authors.forename: I
authors.initials: I
authors.lastname: Chagnon
authors.forename: G
authors.initials: G
authors.lastname: Le Gal
authors.forename: S
authors.initials: S
authors.lastname: Solymoss
authors.forename: M A
authors.initials: MA
authors.lastname: Crowther
authors.forename: A
authors.initials: A
authors.lastname: Perrier
authors.forename: R H
authors.initials: RH
authors.lastname: White
authors.forename: L M
authors.initials: LM
authors.lastname: Vickars
authors.forename: T
authors.initials: T
authors.lastname: Ramsay
authors.forename: S R
authors.initials: SR
authors.lastname: Kahn
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D004108:Dilatation, Pathologic; D016903:Drug Monitoring / Q000379:methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D054070:Postthrombotic Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014680:Veins / Q000473:pathology; D014689:Venous Insufficiency / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000925:Anticoagulants