Connection of Postthrombotic Syndrome Development with Markers of Inflammation, Coagulation, and Endothelial Dysfunction in Patients on Prolonged Anticoagulation

Petrikov A.S.; Dudin D.V.; Popkova L.N.

doi:https://doi.org/10.17116/flebo202014041275

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OBJECTIVE

To study the incidence and severity of clinical manifestations, as well as the odds ratio of PTS development on the background of 12-month antithrombotic therapy (ATT) considering the level of D-dimer, C-reactive protein (CRP) and homocysteine (HC) in patients with proximal DVT.

MATERIAL AND METHODS

A comparative analysis of the incidence of clinical manifestations and odds ratio (OR) of PTS development included 179 patients with previous proximal DVT. Villalta scale was used for assessment. We also considered serum markers of inflammation, hemostasis and ED in 4-6 and 10-12 months after ATT onset. Depending on Villalta score, 79 patients without symptoms of PTS comprised group I (34 males and 45 females aged 48.6±1.6 years), group II — 100 patients (49 males and 51 females aged 48.9±2.2 years) with manifestations of PTS. The control group consisted of 117 healthy persons (54 males and 63 females aged 50.1±1.7 years).

RESULTS

Annual incidence of PTS after previous proximal DVT followed by ATT was 55.9%. According to the Villalta scale, patients with PTS had significantly higher levels of serum CRP, D-dimer and HC at baseline and after a year compared to the control group. Moreover, these values after 4-6 and 10-12 months were also higher compared to patients without clinical manifestations of PTS. Serum D-dimer >500.0 ng/ml after a year is associated with 1.8-fold increase of OR of PTS development (95% CI 1.43-2.21, p<0.01), CRP >5.0 mg/L — 1.9-fold increase (95% CI 1.55-2.30, p<0.01), HC >11.0 mmol/L — 1.9-fold increase (95% CI 1.52-2.47, p<0.01). Serum CRP >3.0 mg/L, D-dimer >250 ng/ml and HC >11.0 µmol/L are associated with 5.7-fold increase of OR of moderate PTS development (95% CI 2.67-11.97; p<0.01), and 19.1-fold increase for severe PTS (95% CI 4.79-75.94; p<0.01).

CONCLUSION

Annual incidence and severity of PTS may be closely related to the above-mentioned serum biomarkers. Analysis of D-dimer, CRP and HC after 4-6 and 10-12 months in patients with proximal idiopathic DVT followed by prolonged anticoagulation is valuable to predict the risk and severity of PTS.

Keywords:

deep vein thrombosis

postthrombotic syndrome

D-dimer

C-reactive protein

homocysctein

Villalta scale

Authors:

Petrikov A.S.

Altai State Medical University;
Diagnostic Center of Altai Territory

SPIN RSCI: 4612-6452
Scopus AuthorID: 56771302600
ORCID: 0000-0002-6501-3289

Dudin D.V.

Barnaul City Clinical Hospital No. 5

Popkova L.N.

Barnaul City Hospital No. 5

Received:

11.04.2020

Accepted:

10.06.2020

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References:

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