Abstract
In patients with deep-vein thrombosis (DVT) in the lower limbs, venous ulcer is the
most debilitating and end-stage clinical expression of the post-thrombotic syndrome
(PTS). To date, risk factors for PTS-related ulcer in DVT patients have not been identified.
We used the international observational RIETE registry to assess the evolution of
PTS signs and symptoms during a 3-year follow-up period and to identify independent
predictors of PTS ulcer at 1 year in patients with acute DVT.
Among 1,866 eligible patients, cumulative rates of PTS ulcer at 1, 2 and 3 years were
2.7% (n = 50), 4.3% (n = 54) and 7.1% (n = 60), respectively. The proportion of patients with PTS symptoms at 1, 2 or 3 years
remained stable (≈40%), while the proportion of patients with PTS signs increased
slightly over time (from 49 to 53%). Prior history of venous thromboembolism (VTE)
(odds ratio [OR] = 5.5 [2.8–10.9]), diabetes (OR = 2.3 [1.1–4.7]), pre-existing leg
varicosities (OR = 3.2 [1.7–6.1]) and male sex (OR = 2.5 [1.3–5.1]) independently
increased the risk of PTS ulcer at 1 year. Obesity also increased the risk but failed
to reach statistical significance (OR = 1.8 [0.9–3.3]). DVT treatment characteristics
(duration or drug) did not influence the risk.
Our results evidence that after acute DVT, pre-existing leg varicosities, prior venous
thromboembolism, diabetes and male gender independently increased the risk for PTS
ulcer. This suggests that clinicians should consider strategies aimed to prevent ulcers
in high-risk DVT patients, such as preventing VTE recurrence, use of stockings in
those with pre-existing venous insufficiency, careful monitoring of diabetic patients
and encouraging weight loss in obese patients.
Keywords
epidemiological studies - post-thrombotic syndrome - venous ulcer - venous thrombosis
- deep-vein thrombosis
