The response of lower limb deep vein thrombosis to anticoagulation therapy: resolution, recurrence and post thrombotic syndrome

Bonfield, Michelle

Abstract

Objective:
To examine the natural history and response to treatment of deep vein thrombosis (DVT) and assess associations between baseline or follow-up characteristics and longer term outcomes.
Methods:
A literature review and survey of clinical vascular scientists were undertaken to inform a prospective observational study. 171 consecutive participants with a first episode of acute DVT were followed-up at defined intervals for up to two years. Ultrasound was used to examine changes in thrombus and venous function. A medical history and presenting symptoms were recorded for each patient at baseline and each research visit. Post thrombotic syndrome (PTS) was assessed using the Villalta score. Possible predictors of outcome after DVT were analysed using multivariate logistic regression.
Results:
In 34% of cases DVT remained unresolved when prescribed anticoagulation treatment ceased and in 27% it remained unresolved at two years post diagnosis. Recurrent DVT during follow-up was detected in 15%, new venous incompetence developed in 28% and PTS developed in 30%. Following adjustment for confounding, distal DVT and cases with lower thrombus burden were significantly more likely to resolve. The development of venous incompetence was associated with proximal DVT and treatment with heparin and warfarin rather than Rivaroxaban. Women were more likely to develop PTS than men. PTS was also associated with being overweight, residual DVT, not using compression stockings, superficial venous incompetence and deep venous incompetence when combined with superficial incompetence. No significant associations were found between PTS and treatment duration, smoking, hypertension, provocation status, pre-existing incompetence, superficial thrombophlebitis, symptoms duration, thrombus evolution pattern, or recurrence.
Conclusions:
This study has provided data that could inform future patient education and lifestyle advice. It has also provided preliminary data to inform risk stratification for PTS and individually tailored treatment for DVT.

• Thesis Type: Thesis
• Publicly Available Date: Jul 16, 2019
• Public URL: https://uwe-repository.worktribe.com/output/1491001
• Contract Date: Jul 16, 2019