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Markers of coagulation, fibrinolysis and inflammation in relation to post‐thrombotic syndrome
Author(s) -
BOUMAN A. C.,
SMITS J. J. M.,
TEN CATE H.,
TEN CATEHOEK A. J.
Publication year - 2012
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2012.04798.x
Subject(s) - medicine , interquartile range , post thrombotic syndrome , gastroenterology , odds ratio , confidence interval , c reactive protein , d dimer , thrombosis , venous thrombosis , surgery , inflammation
Summary. Background: Post‐thrombotic syndrome (PTS) occurs in 20–50% of patients after a deep venous thrombosis (DVT). It is difficult to accurately predict which patients will develop PTS. Biomarkers could be a valuable tool for PTS risk assessment. Objectives: To investigate whether increased levels of factor (F)VIII, C‐reactive protein (CRP) or D‐dimer, over time, are associated with the development of PTS in patients after an acute DVT. Methods: PTS status was assessed using the Villalta scale. Blood sampling was performed at three points during follow‐up. Results: A cohort of 228 consecutive patients was included after an acute DVT. At T1 (12 months after index DVT), both levels of D‐dimer (median 725 ng mL −1 [interquartile range, IQR 400–1400[ vs. 378 ng mL −1 [251–652] P = 0.004) and CRP (median 3.9 mg L −1 [IQR 1.6–8.5] vs. 2.4 mg L −1 [1.0–4.3] P = 0.018) were increased in patients with PTS, compared with patients without PTS. Factor (F)VIII was not associated with PTS. In the multivariate logistic regression analysis, varicosities (odds ratio [OR] 13.4 95% confidence interval [CI] 3.0–59.1 P = 0.001), a previous ipsilateral DVT (OR 6.3 95% CI 1.5–26.9 P = 0.012) and CRP > 5 mg L −1 on T1 (OR 8.0 95% CI 2.4–26.4 P = 0.001) were significantly associated with PTS. Conclusions: Besides previous ipsilateral DVT and varicosities, CRP > 5 mg L −1 at T1 was strongly and independently associated with PTS. Persistent inflammation rather than hypercoagulability might be the most important etiological factor in PTS, and may be a target for future therapy. The development of a risk score for PTS, including both clinical risk factors and biomarker levels, such as CRP, might be desirable.