Narrative Reviews
Vol. 1 No. 1 (2022)
New perspectives for prevention of the post-thrombotic syndrome
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 10 February 2022
Accepted: 8 March 2022
Accepted: 8 March 2022
1633
Views
488
Downloads
Authors
While on conventional anticoagulation, up to 50% of patients with one or more episodes of proximal deep vein thrombosis (DVT) can develop post-thrombotic (PTS) manifestations. The potential strategies for PTS prevention are the treatment of acute DVT with catheter-directed thrombolysis (CDT), the use of elastic compression stockings (ECS) and that of the direct oral anticoagulants (DOAC) in place of vitamin K antagonists (VKA) for the initial and long-term treatment of DVT. Based on the results of three randomized clinical trials, CDT cannot be recommended on a routine basis because of its invasiveness, the associated risk of major bleedings and the uncertainty about its efficacy. According to the results of a placebo-controlled randomized clinical trial, ECS are no longer recommended for PTS prevention on a routine basis. However, based on the results of a recent subanalysis of a prospective cohort study, patients with residual vein thrombosis and/or popliteal valve reflux at three months are likely to benefit from ECS for at least six months. Finally, following the demonstration that the inadequacy of VKA therapy plays a key role in the PTS development, several retrospective and prospective studies have shown that the use of DOACs for the initial and long-term treatment of DVT in place of VKAs reduces the risk of PTS by approximately 50%. In conclusion, the availability of DOACs and the potential of ECS in selected patients with proximal DVT are expected to play a key role for decreasing the rate and the severity of PTS in the forthcoming years.
Downloads
Download data is not yet available.
Citations
Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation 2014;130:1636-61. DOI: https://doi.org/10.1161/CIR.0000000000000130
Visonà A, Quere I, Mazzolai L, et al. Post-thrombotic syndrome. Vasa 2021;50:331-40. DOI: https://doi.org/10.1024/0301-1526/a000946
Guanella R, Ducruet T, Johri M, et al. Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation. J Thromb Haemost 2011;9:2397-405. DOI: https://doi.org/10.1111/j.1538-7836.2011.04516.x
Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996;125:1-7. DOI: https://doi.org/10.7326/0003-4819-125-1-199607010-00001
Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008;149:698-707. DOI: https://doi.org/10.7326/0003-4819-149-10-200811180-00004
Rabinovich A, Kahn SR. The postthrombotic syndrome: current evidence and future challenges. J Thromb Haemost 2017;15:230-41. DOI: https://doi.org/10.1111/jth.13569
Rabinovich A, Cohen JM, Cushman M, et al. Inflammation markers and their trajectories after deep vein thrombosis in relation to risk of postthrombotic syndrome. J Thromb Haemost 2015;13:398-408. DOI: https://doi.org/10.1111/jth.12814
Rabinovich A, Ducruet T, Kahn SR. Development of a clinical prediction model for the postthrombotic syndrome in a prospective cohort of patients with proximal deep vein thrombosis. J Thromb Haemost 2018;16:262-70. DOI: https://doi.org/10.1111/jth.13909
Rabinovich A, Gu CS, Vedantham S, et al. External validation of the SOX-PTS score in a prospective multicenter trial
of patients with proximal deep vein thrombosis. J Thromb Haemost 2020;18:1381-9. DOI: https://doi.org/10.1111/jth.14791
Amin EE, Ten Cate-Hoek AJ, Bouman AC, et al. Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome: a cost-effectiveness analysis. Lancet Haematol 2018;5:e512-9. DOI: https://doi.org/10.1016/S2352-3026(18)30151-0
Amin EE, van Kuijk SMJ, Joore MA, et al. Development and validation of a practical two-step prediction model and clinical risk score for post-thrombotic syndrome. Thromb Haemost 2018;118:1242-9. DOI: https://doi.org/10.1055/s-0038-1655743
Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 2017;377:2240-52. DOI: https://doi.org/10.1056/NEJMoa1615066
Comerota AJ, Kearon C, Gu CS, et al. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation 2019;139:1162-73. DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.037425
Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 2012;379:31-8. DOI: https://doi.org/10.1016/S0140-6736(11)61753-4
Haig Y, Enden T, Grøtta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis
(CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol 2016;3:e64-71. DOI: https://doi.org/10.1016/S2352-3026(15)00248-3
Notten P, Ten Cate-Hoek AJ, Arnoldussen CWKP, et al. Ultrasound-accelerated catheter-directed thrombolysis versus anticoagulation for the prevention of post-thrombotic syndrome (CAVA): a single-blind, multicentre, randomised trial. Lancet Haematol 2020;7:e40-9. DOI: https://doi.org/10.1016/S2352-3026(19)30209-1
Notten P, de Smet AAEA, Tick LW, et al. CAVA (ultrasoundaccelerated catheter-directed thrombolysis on preventing post-thrombotic syndrome) trial: long-term follow-up results. J Am Heart Assoc 2021;10:e018973. DOI: https://doi.org/10.1161/JAHA.120.018973
Brandjes DP, Büller HR, Heijboer H, et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997;349:759-62. DOI: https://doi.org/10.1016/S0140-6736(96)12215-7
Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004;141:249-56. DOI: https://doi.org/10.7326/0003-4819-141-4-200408170-00004
Kahn SR, Shapiro S, Wells PS, et al. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 2014;383:880-8. DOI: https://doi.org/10.1016/S0140-6736(13)61902-9
Stevens SM, Woller SC, Baumann Kreuziger L, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report - Executive summary. Chest 2021;160:2247-59. DOI: https://doi.org/10.1016/j.chest.2021.07.056
Rabe D, Partsch H, Heidl G, et al. Compression treatment in acute symptomatic proximal deep venous thrombosis Results of a worldwide survey. Phlebology 2021;36:526-34. DOI: https://doi.org/10.1177/02683555211003801
Mol GC, van de Ree MA, Klok FA, et al. One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): randomised controlled trial. BMJ 2016;353:i2691. DOI: https://doi.org/10.1136/bmj.i2691
Subbiah R, Aggarwal V, Zhao H, et al. Effect of compression stockings on post thrombotic syndrome in patients with deep vein thrombosis: a meta-analysis of randomised controlled trials. Lancet Haematol 2016;3:e293-300. DOI: https://doi.org/10.1016/S2352-3026(16)30017-5
Dronkers CEA, Mol GC, Maraziti G, et al. Predicting postthrombotic syndrome with ultrasonographic follow-up after deep vein thrombosis: a systematic review and meta-analysis. Thromb Haemost 2018;118:1428-38. DOI: https://doi.org/10.1055/s-0038-1666859
Prandoni P, Lensing AW, Prins MH, et al. The impact of residual thrombosis on the long-term outcome of patients with deep venous thrombosis treated with conventional anticoagulation. Semin Thromb Hemost 2015;41:133-40. DOI: https://doi.org/10.1055/s-0035-1544161
Prandoni P, Lensing AW, Prins MH, et al. Elastic compression stockings for prevention of the post-thrombotic syndrome in patients with and without residual vein thrombosis and/or popliteal valve reflux. Haematologica 2022;107:303-7. DOI: https://doi.org/10.3324/haematol.2021.279680
van Dongen CJ, Prandoni P, Frulla M, et al. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost 2005;3:939-42. DOI: https://doi.org/10.1111/j.1538-7836.2005.01333.x
Hull RD, Liang J, Townshend G. Long-term low-molecular-weight heparin and the post-thrombotic syndrome: a systematic review. Am J Med 2011;124:756-65. DOI: https://doi.org/10.1016/j.amjmed.2011.02.033
Makedonov I, Kahn SR, Abdulrehman J, et al. Prevention of the postthrombotic syndrome with anticoagulation: a narrative
review. Thromb Haemost 2021 Dec 1. doi: 10.1055/a-1711-1263 [online ahead of print]. DOI: https://doi.org/10.1055/a-1711-1263
van Es N, Coppens M, Schulman S, et al. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood 2014;124:1968-75. DOI: https://doi.org/10.1182/blood-2014-04-571232
Prandoni P, Ageno W, Mumoli N, et al. Recanalization rate in patients with proximal vein thrombosis treated with the direct oral anticoagulants. Thromb Res 2017;153:97-100. DOI: https://doi.org/10.1016/j.thromres.2017.03.022
Prandoni P, Ageno W, Ciammaichella M, et al. The risk of post-thrombotic syndrome in patients with proximal deep vein thrombosis treated with the direct oral anticoagulants. Intern Emerg Med 2020;15:447-52. DOI: https://doi.org/10.1007/s11739-019-02215-z
Li R, Yuan M, Cheng J, Yu S, et al. Risk of post-thrombotic syndrome after deep vein thrombosis treated with rivaroxaban versus vitamin-K antagonists: a systematic review and meta-analysis. Thromb Res 2020;196:340-8. DOI: https://doi.org/10.1016/j.thromres.2020.09.014
Prins MH, Lensing AWA, Prandoni P, et al. Risk of recurrent venous thromboembolism according to baseline risk factor profiles. Blood Adv 2018;2:788-96. DOI: https://doi.org/10.1182/bloodadvances.2018017160
Agnelli G, Buller HR, Cohen A, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med
;368:699-708.
How to Cite
1.
Prandoni P. New perspectives for prevention of the post-thrombotic syndrome. Bleeding Thromb Vascul Biol [Internet]. 2022 Mar. 22 [cited 2025 Nov. 9];1(1). Available from: https://www.btvb.org/btvb/article/view/20
Copyright (c) 2022 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Share
Similar Articles
- CO17 | Clinical relevance of isolated anti-phosphatidylserine/ prothrombin antibody positivity , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO58 | Gender differences in primary haemostasis , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- Domenico Prisco, Irene Mattioli, Raffaele De Caterina, Alessandra Bettiol, The new era of anticoagulation: factor XI and XII inhibitors , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 2 (2023)
- Pantep Angchaisuksiri, Wolfram Ruf, Jeffrey Weitz, Sam Schulman, Guy A. Young, A commitment to global collaboration, welcoming international participation and advancing science for the benefit of patients , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 2 (2025)
- Rita Carlotta Santoro, Roberto Minici, Marzia Leotta, Mariapia Falbo, Lucia Concetta Elia, Francesca Leo, Antonella Ierardi, Alessandra Strangio, Simona Prejanò, Vaccine-induced immune thrombotic thrombocytopenia following ChAdOx1 nCoV-19 vaccine: report of two cases , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Daniela Poli, Riccardo Tartaglia, Doris Barcellona , Paolo Bucciarelli , Antonio Ciampa, Elvira Grandone, Giuseppe Malcangi, Giuseppe Rescigno, Vincenzo Toschi, Sophie Testa, Alessandro Squizzato, Attitude to clinical research among health professionals affiliated with the Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies (FCSA) , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 1 (2023)
- Vittorio Pengo, Luca Sarti, Emilia Antonucci, Stefania Di Agostino, Elisa Bison, Gentian Denas, Daniela Poli, Pier Luigi Meroni, Roberto Gerli, Antonella Radice, Gualtiero Palareti, on behalf of FIRMA group and START collaborators, Descriptive analysis of patients positive for anti-phospholipid antibodies included in two Italian registries , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Bianca Clerici, Mariangela Scavone, Gian Marco Podda, Recent advances in classic heparin-induced thrombocytopenia (HIT), autoimmune HIT, spontaneous HIT, and vaccine-induced immune thrombotic thrombocytopenia , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 2 (2024)
- Daniela Tormene, Elena Campello, Chiara Simion, Anna Poretto, Paolo Prandoni, Paolo Simioni, Combined oral contraceptives and the risk of venous thromboembolism carriers of antithrombin, protein C or S deficiency: Sub-analysis of a prospective cohort study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
- Rosina Albisinni, Tommaso Marrazzo, Arta Karruli, Sabrina Manduca, Giuseppe Nobile, Nicola Galdieri, Marisa De Feo, Successful treatment of aortic arch mural thrombosis with low-dose, ultra-slow-flow thrombolysis: a case report and literature review , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
You may also start an advanced similarity search for this article.
Most read articles by the same author(s)
- Paolo Prandoni, Franca Bilora, Raffaele Pesavento, Giorgina Salgueiro, Angeles Blanco-Molina, Raquel Lòpez-Reyes, Manuel Monreal, and the RIETE Investigators, Treatment of venous thromboembolism in pregnancy: findings from the RIETE Registry , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Paolo Simioni, Vittorio Pengo, Paolo Prandoni, Thrombosis and hemostasis at the University of Padua: a reappraisal on the occasion of its 800th year of history , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
- Paolo Prandoni, Personalized bleeding risk assessment for atrial fibrillation patients on direct oral anticoagulants: the DOAC score , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Gualtiero Palareti, Paolo Prandoni, Cristina Legnani, Emilia Antonucci, Serena Zorzi, Alberto Tosetto, Lorenza Bertù, Sophie Testa, Vittorio Pengo, Walter Ageno, Ida Martinelli, Benilde Cosmi, Eugenio Bucherini, Daniela Poli, Rationale and design of a study on D-dimer use to stratify patients after a first unprovoked venous thromboembolism for their risk of recurrence: extended low-dose Apixaban given only to patients with positive D-dimer results , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 1 (2022)
- Daniela Tormene, Elena Campello, Chiara Simion, Anna Poretto, Paolo Prandoni, Paolo Simioni, Combined oral contraceptives and the risk of venous thromboembolism carriers of antithrombin, protein C or S deficiency: Sub-analysis of a prospective cohort study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
- Giuseppe Camporese, Paolo Prandoni, Walter Ageno, Aspirin or low-molecular weight heparin for thromboprophylaxis after a fracture? That is the question , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 2 (2023)
