title: Predictors for the development of post-thrombotic syndrome in patients with primary lower limb deep venous thrombosis: A case-control study.
abstract: Introduction Post-thrombotic syndrome is a common and debilitating sequelae of lower limb deep venous thrombosis. Very little awareness is present about the risk factors and about the diagnosis, prevention, and treatment of this condition. Objective The objective of this study is to identify the predictors of post-thrombotic syndrome after lower limb deep venous thrombosis. Materials and methods A case-control study was conducted on all adult patients who were admitted with lower limb deep venous thrombosis at our institution from January 2005 to June 2012. These patients were scheduled for a research clinic visit, which included informed consent, data collection, and physical examination. Patients found to have post-thrombotic syndrome served as cases and those without post-thrombotic syndrome served as controls. Villalta scoring system was used to diagnose the post-thrombotic syndrome and then to assess the severity of the condition in both the groups. Cox regression risk factor analysis was performed to identify the predictors of post-thrombotic syndrome. Results Out of the 125 patients examined, 49 were found to have post-thrombotic syndrome. Risk factors found to be significant were body mass index of more than 35 kg/m2( n = 13, p = 0.003), history of immobilization ( n = 19, p = 0.003), one or more hypercoagable disorders ( n = 32, p = 0.02), iliofemoral deep venous thrombosis ( n = 18, p = 0.001), complete obstruction on ultrasound ( n = 26, p = 0.016), unstable range of international normalized ratio ( n = 23, p = 0.041) and non-compliance for the use of compressions stockings ( n = 14, p = 0.001). On multivariate analysis, one or more hypercoagable disorder, iliofemoral deep venous thrombosis, and non-compliance to the use of compression stockings were found to be independent risk factors for the development of post-thrombotic syndrome. Conclusion One or more hypercoagable disorders, iliofemoral deep venous thrombosis and non-compliance to the use of compression stockings were independent predictors of post-thrombotic syndrome after deep venous thrombosis. These findings will help prognosticate and prevent development of PTS in similar patient populations.
authors.affiliation: 1 Department of Surgery, AGA Khan University Hospital, Karachi, Pakistan.
authors.forename: Nadeem A
authors.initials: NA
authors.lastname: Siddiqui
authors.affiliation: 1 Department of Surgery, AGA Khan University Hospital, Karachi, Pakistan.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Sophie
authors.affiliation: 2 Cincinnati Children's Hospital, Cincinnati, USA.
authors.forename: Farhan
authors.initials: F
authors.lastname: Zafar
authors.affiliation: 1 Department of Surgery, AGA Khan University Hospital, Karachi, Pakistan.
authors.forename: Delvene
authors.initials: D
authors.lastname: Soares
authors.affiliation: 1 Department of Surgery, AGA Khan University Hospital, Karachi, Pakistan.
authors.forename: Iram
authors.initials: I
authors.lastname: Naz
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000150:complications; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010154:Pakistan; D010349:Patient Compliance; D054070:Postthrombotic Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D053828:Stockings, Compression; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy
keywords: Post-thrombotic syndrome; Villalta score; deep vein thrombosis