title: Relationship between development of post-thrombotic syndrome and serial ultrasound, D-dimer, and factor VIII activity after a first deep venous thrombosis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the relationship of post-thrombotic syndrome (PTS) with residual vein thrombosis, deep venous reflux (DVT), D-dimer, and factor VIII (FVIII) after a first deep venous thrombosis (DVT).
  
  
  METHODS
  There were 133 participants with objectively confirmed DVT, of whom 114 were observed for 6 months after completion of anticoagulation. Ultrasound, D-dimer, and FVIII evaluations were undertaken at 6 weeks after completion of anticoagulation and at the end of follow-up. PTS was considered present in those with a score of ≥5 on the Villalta scale at either assessment.
  
  
  RESULTS
  The cumulative incidence of PTS was 51.8%, with median duration of follow-up of 11 months. Median D-dimer and FVIII in those with PTS were significantly higher at both time points compared with those without. Similarly, residual vein thrombosis and deep venous reflux were more prevalent in those with PTS at both study assessments. On multivariable analysis, only FVIII at end of study remained significantly associated with PTS with an odds ratio of 2.83 (95% confidence interval, 1.09-7.42; P = .034). Ultrasound markers and D-dimer were not significantly associated with PTS after adjustment for age, body mass index, Charlson Index ≥1, and proximal extent of DVT.
  
  
  CONCLUSIONS
  FVIII activity at end of follow-up was independently associated with PTS, suggesting underlying activation of coagulation.
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, London, United Kingdom. Electronic address: lara.roberts@nhs.net.
authors.forename: Lara N
authors.initials: LN
authors.lastname: Roberts
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, London, United Kingdom.
authors.forename: Raj K
authors.initials: RK
authors.lastname: Patel
authors.affiliation: Vascular Laboratory, Department of Medical Engineering & Physics, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: David E
authors.initials: DE
authors.lastname: Goss
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, London, United Kingdom.
authors.forename: Paradzai
authors.initials: P
authors.lastname: Chitongo
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, London, United Kingdom.
authors.forename: Lynda
authors.initials: L
authors.lastname: Bonner
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, London, United Kingdom.
authors.forename: Roopen
authors.initials: R
authors.lastname: Arya
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005169:Factor VIII / Q000032:analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D054070:Postthrombotic Syndrome / Q000000981:diagnostic imaging / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D013577:Syndrome; D013927:Thrombosis; D013997:Time Factors; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005169:Factor VIII