Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis

被引:56
作者
Amin, Elham E. [1 ,2 ,3 ]
Bistervels, Ingrid M. [4 ,5 ]
Meijer, Karina [6 ]
Tick, Lidwine W. [7 ]
Middeldorp, Saskia [5 ]
Mostard, Guy [8 ]
van de Poel, Marlene [9 ]
Serne, Erik H. [10 ]
Otten, Hans M. [11 ]
Klappe, Edith M. [12 ]
Joore, Manuela A. [3 ]
ten Cate, Hugo [1 ,2 ]
ten Wolde, Marije [4 ]
ten Cate-Hoek, Arina J. [1 ,2 ]
机构
[1] Maastricht Univ, Cardiovasc Res Inst Maastricht, Dept Biochem, POB 616, NL-6200 MD Maastricht, Netherlands
[2] Maastricht Univ, Dept Internal Med, Med Ctr, Maastricht, Netherlands
[3] Maastricht Univ, Sch Publ Hlth & Primary Care, Dept Clin Epidemiol & Med Technol Assessment, Maastricht, Netherlands
[4] Flevoziekenhuis, Dept Internal Med, Almere, Netherlands
[5] Acad Med Ctr Amsterdam, Dept Internal Med, Amsterdam, Netherlands
[6] Univ Groningen, Univ Med Ctr Groningen, Dept Hematol, Groningen, Netherlands
[7] Maxima Med Ctr Eindhoven, Dept Internal Med, Eindhoven, Netherlands
[8] Zuyderland Med Ctr, Dept Internal Med, Heerlen, Netherlands
[9] Laurentius Hosp, Dept Internal Med, Roermond, Netherlands
[10] Vrije Univ, Dept Internal Med, Med Ctr, Amsterdam, Netherlands
[11] Med Ctr Slotervaart, Dept Internal Med, Amsterdam, Netherlands
[12] Univ Med Ctr Nijmegen, Dept Internal Med, Nijmegen, Netherlands
关键词
VENOUS THROMBOSIS; RESIDUAL THROMBOSIS; RISK-FACTORS; 1ST EPISODE; THERAPY; QUALITY; THROMBOEMBOLISM; COMPLICATIONS; POPULATION; PREDICTORS;
D O I
10.1182/blood-2018-03-836783
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Thus far, the association between residual vein occlusion and immediate compression therapy and postthrombotic 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 postthrombotic syndrome and recurrent venous thromboembolism. In a prespecified substudy within the IDEAL (individualized duration of elastic compression therapy against long-term duration of therapy for prevention of postthrombotic syndrome) deep vein thrombosis (DVT) study, 592 adult patients from 10 academic and nonacademic centers across The Netherlands, with objectively confirmed proximal DVT of the leg, received no compression or acute compression within 24 hours of diagnosis of DVT with either multilayer bandaging or compression hosiery (pressure, 35 mm Hg). Presence of RVO and recurrent venous thromboembolism was confirmed with compression ultrasonography and incidence of postthrombotic syndromeas a Villalta score of at least 5 at 6 and 24 months. The average time from diagnosis until assessment of RVO was 5.3 (standard deviation, 1.9) months. A significantly lower percentage of patients who did receive compression therapy immediately after DVT had RVO (46.3% vs 66.7%; odds ratio, 0.46; 95% confidence interval, 0.27-0.80; P = .005). Postthrombotic syndrome was less prevalent in patients without RVO (46.0% vs 54.0%; odds ratio, 0.65; 95% confidence interval, 0.46-0.92; P = .013). Recurrent venous thrombosis showed no significant association with RVO. Immediate compression should therefore be offered to all patients with acute DVT 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).
引用
收藏
页码:2298 / 2304
页数:7
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