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Residual vein occlusion in relation to immediate compression and postthrombotic syndrome in deep vein thrombosis

Elham E. Amin, Ingrid M. Bistervels, Karina Meijer, Lidwine W. Tick, Saskia Middeldorp, Guy Mostard, Marlène van de Poel, Erik H. Serné, Hans M. Otten, Edith M. Klappe, Manuela A. Joore, Hugo ten Cate, Marije ten Wolde and Arina J. Ten Cate-Hoek

Key points

  • Immediate compression therapy after deep venous thrombosis is associated with a 20% absolute reduction of residual vein occlusion.

  • The reduction of residual thrombosis is associated with an 8% absolute reduction of post thrombotic syndrome at 24 months.

Abstract

Thus far the association between residual vein occlusion and immediate compression therapy and post thrombotic syndrome is undetermined. Therefore, we investigated whether compression therapy immediately after diagnosis of deep vein thrombosis affects the occurrence of residual vein obstruction, (RVO) and whether the presence of RVO is associated with post thrombotic syndrome and recurrent venous thromboembolism. In a pre-specified sub study within the IDEAL DVT trial, 592 adult patients from 10 academic and non-academic centers across the Netherlands, with objectively confirmed proximal deep vein thrombosis of the leg, received no compression or acute compression within 24 hours of diagnosis of deep vein thrombosis with either multi-layer bandaging or compression hosiery (pressure 35mmHg). Presence of RVO and recurrent venous thromboembolism was confirmed with compression ultrasonography, incidence of post thrombotic syndrome as a Villalta score of >5 at 6 and 24 months. The average time from diagnosis until assessment of RVO was 5.3 (SD 1.9) months. A significantly lower percentage of patients who did receive compression therapy immediately after deep vein thrombosis had RVO, (46.3% versus 66.7%; OR 0.46 95% CI 0.27 to 0.80; p=0.005). Post thrombotic syndrome was less prevalent in patients without RVO (46.0 % versus. 54.0%; OR 0.65 95%CI 0.46 to 0.92; p=0.013). Recurrent venous thrombosis showed no significant association with RVO. Immediate compression should therefore be offered to all patients with acute deep venous thrombosis of the leg irrespective of severity of complaints. This study was registered at ClinicalTrials.gov (NCT01429714) and the Dutch Trial registry in November 2010 (NTR2597).

  • Submitted March 1, 2018.
  • Accepted July 2, 2018.