Background: In spite of a rising number of reports on venous thromboembolic disease treatment, the occurence of post-thrombotic syndrome in patients with proximal deep vein thrombosis remains high, and runs into 29-79%. In this study, the efficacy of anticoagulant treatment and compression therapy in post-thrombotic syndrome prevention was evaluated, depending on the treatment period, severity and localization of the proximal vein thrombosis.
Material and methods:100 patients with proximal deep vein thrombosis (medium age 55.7 years; 18-80) referred to the Department of General and Vascular Surgery Medical University of Silesia in 1996-2002, were enrolled in the study. All patients underwent anticoagulant treatment and were recommended to use compression therapy consistent with the current guidelines. Patients were evaluated during a follow-up of 1-7 years after the first episode of venous thrombosis (medium period of observation 53.9 months). During check-up examinations, the symptoms connected with the post-thrombotic syndrome incidence, in accordance with the Villalta scale, were assessed and color Doppler ultrasounds of the deep vein systems were performed. The actual period of anticoagulant treatment, compression therapy and the influence of those factors on the post-thrombotic syndrome development were also estimated.
Results: Venous thromboembolism recurrence was observed in 13% of patients. On the basis of their clinical history it was noted that 8% of patients had not used pharmacological secondary prophylaxis, which was a consequence of the lack of compliance with the medical recommendations. Moreover, 11% had used secondary prophylaxis during a period of less than 1 month, and 12% than 3 months. The secondary prophylaxis period in the remaining 69% of patients was described as appropriate to the diagnosed disease. The presence of symptoms that enable one to diagnose post-thrombotic syndrome (> 4 pts. in Villallta scale) were noted in 75% of studied population, where 54% were of a low or medium degree (Villallta scale 5-14 pts.) and 21% of a severe degree (> 14 pts.). The presence of venous ulcers was observed in 7% of patients. No significant differences in the occurence of post-thrombotic syndrome, depending on the type of anticoagulant therapy used in the initial treatment and secondary prophylaxis, were noted. Taking into consideration the influence of other factors analized in the study, we found a correlation between the increase in the occurence of post-thrombotic syndrome and thrombosis recurrence in the long-term follow-up, and lack of the constant compression therapy use and venous thrombosis extent (multisegmental localization of venous thrombosis in the limb).
Conclusions: 1. Despite the use of compression therapy, anticoagulant treatment and immediate mobilization, there is no effective and certain method of post-thrombotic syndrome prevention in patients with proximal deep vein thrombosis when treated conservatively.
2. From the late onset of the symptoms every patient after proximal deep vein thrombosis should be observed without exception in the long-term follow-up and verified in the field of compliance with anticoagulant treatment and compression therapy.
3. Long-term, permanent compression therapy use influences a decrease in the percentage of patients with post-thrombotic sequelae in the population with proximal deep vein thrombosis.