Thromb Haemost 2018; 118(08): 1428-1438
DOI: 10.1055/s-0038-1666859
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Predicting Post-Thrombotic Syndrome with Ultrasonographic Follow-Up after Deep Vein Thrombosis: A Systematic Review and Meta-Analysis

C. E. A. Dronkers
1  Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
,
G. C. Mol
2  Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
,
G. Maraziti
3  Internal and Cardiovascular Medicine–Stroke Unit, University of Perugia, Perugia, Italy
,
M. A. van de Ree
4  Department of Internal Medicine, Diakonessenhuis Hospital, Utrecht, The Netherlands
,
M. V. Huisman
1  Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
,
C. Becattini
3  Internal and Cardiovascular Medicine–Stroke Unit, University of Perugia, Perugia, Italy
,
F. A. Klok
1  Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
› Author Affiliations
Further Information

Publication History

18 September 2018

17 May 2018

Publication Date:
04 July 2018 (online)

Abstract

Background Post-thrombotic syndrome (PTS) is a common and potential severe complication of deep venous thrombosis (DVT). Elastic compression stocking therapy may prevent PTS if worn on a daily basis, but stockings are cumbersome to apply and uncomfortable to wear. Hence, identification of predictors of PTS may help physicians to select patients at high risk of PTS.

Aims This article identifies ultrasonography (US) parameters assessed during or after treatment of DVT of the leg, that predict PTS.

Methods This is a systematic review and meta-analysis study. Databases were searched for prospective studies including consecutive patients with DVT who received standardized treatment, had an US during follow-up assessing findings consistent with vascular damage after DVT and had a follow-up period of at least 6 months for the occurrence of PTS assessed by a standardized protocol.

Results The literature search revealed 1,156 studies of which 1,068 were irrelevant after title and abstract screening by three independent reviewers. After full-text screening, 12 relevant studies were included, with a total of 2,684 analysed patients. Two US parameters proved to be predictive of PTS: residual vein thrombosis, for a pooled odds ratio (OR) of 2.17 (95% confidence interval [CI], 1.79–2.63) and venous reflux at the popliteal level, for a pooled OR of 1.34 (95% CI, 1.03–1.75).

Conclusion The US features reflux and residual thrombosis measured at least 6 weeks after DVT predict PTS. Whether these features may be used to identify patients who may benefit from compression therapy remains to be assessed in further studies.

Authors' Contributions

All authors designed the study and approve the final publication. C.E.A. Dronkers, G.C. Mol and G. Maraziti performed the literature search, study selection and data extraction. C.E.A. Dronkers and F.A. Klok performed the analysis and drafted the paper. G.C. Mol, M.A. van de Ree, M.V. Huisman and C. Becattini critically revised the paper for important intellectual content.