Post-thrombotic syndrome after primary event of deep venous thrombosis 10 to 20 years ago

Aims: We investigated the impact of the extent of primary deep venous throm bosis (DVT) and recurrent thrombotic events in accordance to other presumed prognostic factors for long-term clinical outcome after first DVT. Patient s and methods: All consecutive in-patients, who were treated following firs t acute DVT between January 1, 1978 and December 31, 1988 at the Department of Angiology were identified by admission lists. Localisation, extent of p rimary DVT, etiology and concomitant pulmonary embolism (PE) at the time of initial presentation and occurrence of post-thrombotic syndrome (PTS) at f ollow-up visits were assessed by chart review. The duration and quality of the compression therapy, as well as the accuracy of the oral anticoagulant (OAC) treatment were documented. Recurrence of thrombosis embolism and/or P E with respect to the intensity of OAC was analyzed. Patients were invited to participate in clinical reinvestigation. Patients' history and clinical stage of PTS were reevaluated and patients were asked for compliance in wea ring compression stockings. A survey concerning restriction in quality of l ife was conducted. Hemodynamic measurements by strain-gauge plethysmography (SGP) were performed. Results: One hundred and sixty-one patients were eli gible for the study. Out of these 132 patients, 82% suffered from the PTS, defined as signs of chronic venous insufficiency (CVI) secondary to DVT of the lower limbs: 74 patients (46%) presented with clinical stage I after Wi dmer, 47 patients (29%) with clinical stage II and 11 patients (7%) with cl inical stage III. No sign of PTS was seen in 29 patients (18%). The mean fo llow-up period of 6.6 years was statistically not different between the thr ee severity groups of PTS. The severity of clinical symptoms was significan tly associated with the recurrence of ipsilateral thrombosis (n=26/ 16%). H ighest risk for developing severe PTS was seen after four-level DVT and dee p vein thrombosis of the lower leg. Patients having had a non-sufficient OA C (Hepatoquick >25% in more than 50% of measurements) exhibited worse progr adient clinical stages. Besides the high rate of bleeding complications aft er thrombolytic therapy, this strategy did not show more efficiency in prev ention of development of severe PTS than heparin therapy alone. Conclusion: Our results show that primary four-level DVT, calf vein thrombosis, recurr ence of ipsilateral DVT and a non-sufficient oral anticoagulation are of pr ognostic significance for developing clinically relevant PTS within 10 to 2 0 years after first DVT. (C) 2001 Elsevier Science Ltd. All rights reserved .