P-127 - SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RATE OF POST-THROMBOTIC SYNDROME AFTER ISOLATED DISTAL DEEP VENOUS THROMBOSIS

TOPIC:
Thrombosis
AUTHORS:
Turner B. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Thapar A. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Jasionowska S. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Machin M. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Peerbux S. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Gwozdz A. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Davies A. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom)
Introduction:
The rate of post-thrombotic syndrome (PTS) after ileofemoral deep venous thrombosis (DVT) is as high as 50%, with severe symptoms such as venous ulceration occurring in 10% (Galanaud et al., 2018). However, the manifestation of PTS after isolated distal DVT (IDDVT) has never been formally pooled in a meta-analysis. The objective of this review was to identify the rate of PTS after IDDVT with a secondary objective of identifying the rate of severe manifestations.
Methods:
The review followed PRISMA guidelines using a registered protocol (CRD42021282136). MEDLINE, Embase, the Cochrane Controlled Trials Register, Clinicaltrials.gov, European Union Clinical Trials, International Standard Randomised Controlled Trial Number and the Australian and New-Zealand Trials registries were all searched up to December 2021. Prospective cohort studies and randomised controlled trials reporting the development of PTS after imaging-verified IDDVT were included; studies with less than 6 months follow up were excluded. Data were pooled with a random-effects model via a meta-proportions analysis.
Results:
The results showed a post-thrombotic rate of 17% (95% CI 11-26%) (7 studies, 217 cases, 1105 participants). Heterogeneity was high (I2= 89%). A sensitivity analysis including studies with ≥18 months of follow up, demonstrated the rate of PTS was 22% (95% CI 16-30%) (6 studies, 216 cases, 1053 participants, I2=80%). The rate of post-thrombotic syndrome was not correlated with length of follow up. Three studies (302 participants) reported the severity of post-thrombotic syndrome: 78% were mild (Villalta score 5-9); 11% were moderate (Villalta score 10-14) and 11% were severe (Villalta score 15 or more).
Conclusion:
Below knee deep vein thrombosis confers a 1 in 5 risk of post-thrombotic syndrome. and a 1 in 50 risk of ulceration. There was significant clinical, methodological and statistical heterogeneity between studies and a substantial risk of bias from pooled studies. Randomised trials to support interventions for prevention of post-thrombotic syndrome are urgently needed.
References:
1. Galanaud JP, Monreal M, Kahn SR. Epidemiology of the post-thrombotic syndrome. Thromb Res. 2018;164:100-9.
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