Association between thrombophilia and the post‐thrombotic syndrome: a systematic review and meta‐analysis

Summary Background The postthrombotic syndrome ( PTS ) is a frequent chronic complication of deep vein thrombosis ( DVT ), occurring in 20–40% of patients. Identifying risk factors for PTS may be useful to provide patients with prognostic information and target prevention strategies. Objective To conduct a systematic review to assess whether, among patients with DVT , inherited and acquired thrombophilias are associated with a risk of PTS . Methods We searched the electronic databases P ub M ed, EMBASE , S copus, and W eb of S cience for studies published from 1990 to 2013 that assessed any thrombophilia in adult DVT patients and its association with the development of PTS . We calculated odds ratios and 95% confidence intervals for PTS according to the presence of thrombophilia. Meta‐analysis was performed using the random‐effects model. Results Sixteen studies were included: 13 assessed f actor V L eiden ( FVL ), 10 assessed prothrombin mutation, five assessed protein S and C deficiencies, three assessed antithrombin deficiency, four assessed elevated FVIII levels, and six assessed antiphospholipid antibodies. None of the meta‐analyses identified any thrombophilia to be predictive of PTS . Both FVL and prothrombin mutation appeared protective among studies including patients with both first and recurrent DVT and studies in which more than 50% of patients had an unprovoked DVT . Conclusions Our meta‐analysis did not demonstrate a significant association between any of the thrombophilias assessed and the risk of PTS in DVT patients. Other biomarkers in the pathophysiological pathway may be more predictive of PTS .