Incidence and Predictors of Post-thrombotic Syndrome: Results from GARFIELD-VTE

P. Prandoni¹, A.E. Farjat², S. Haas³, A.G. Turpie⁴, H. Bounameaux⁵, S. Schellong⁶, S.Z. Goldhaber⁷, G. Kayani², M. Carrier⁸, B. Jacobson⁹, W. Ageno¹⁰, J.I. Weitz¹¹, S. Goto¹², P. Angchaisuksiri¹³, L.G. Mantovani^14,15, A.K. Kakkar^2,16

¹Arianna Foundation on Anticoagulation, Bologna, Italy, ²Thrombosis Research Institute, London, United Kingdom, ³Formerly Technical University of Munich, Munich, Germany, ⁴McMaster University, Hamilton, Ontario, Canada, ⁵Faculty of Medicine, University of Geneva, Geneva, Switzerland, ⁶Medical Department 2, Municipal Hospital Dresden, Dresden, Germany, ⁷Brigham and Women’s Hospital and Harvard Medical School, Boston, United States, ⁸Department of Medicine, The Ottawa Hospital, Ottowa, Canada, ⁹Johannesburg Hospital, Johannesburg, South Africa, ¹⁰Department of Medicine and Surgery, University of Insubria, Varese, Italy, ¹¹McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada, ¹²Department of Medicine (Cardiology), Tokai University School of Medicine, Tokyo, Japan, ¹³, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, ¹⁴IRCCS Multimedica, Milan, Italy, ¹⁵University of Milano, Milan, Italy, ¹⁶University College London, London, United Kingdom

Abstract Number: OC 64.4

Meeting: ISTH 2021 Congress

Theme: Venous Thromboembolism » Post-thrombotic Syndrome

Background: Post-thrombotic syndrome (PTS) is the most frequent long-term complication of deep vein thrombosis (DVT) and is commonly diagnosed and graded using the Villalta scale.¹

Aims: Investigate the 36-month incidence of PTS overall and by severity in VTE patients. Determine univariable predictors and test the discriminatory power of a multivariable PTS risk model. Investigate the value of patient self-evaluation via the Villalta scale.

Methods: Eligible participants (n=2,349) from the global GARFIELD-VTE registry of VTE patients underwent physician evaluation for PTS 36-months after VTE diagnosis. Variable selection was performed using stepwise algorithm and PTS predictors were incorporated into a multivariable risk model. Patients completed a Villalta questionnaire at 24-months.

Results: Over 36-months, 25.7% of patients developed incident PTS (mild: 16.9%, moderate: 4.7%, severe: 4.1%). Patients with severe PTS were younger and less likely to have bilateral DVT or concurrent pulmonary embolism than those with no, mild, or moderate PTS. DVT side distribution was comparable among groups. Selected predictors for severe PTS are shown in Table 1. Although compression stockings were not associated with overall PTS (p=0.69), their use was significantly associated with an odds decrease of severe PTS (odds ratio [95% confidence interval] = 0.52 [0.34-0.80]). Baseline anticoagulation was not associated with PTS severity (p=0.67). The severe PTS multivariable model provided good discrimination (Figure 2) with an optimistic adjusted c-index of 0.65 [0.59-0.70]. Self-assessment of overall PTS at 24-months showed an accuracy of 0.74 [0.72-0.77] with respect to physician evaluations, with sensitivity and specificity of 0.66 [0.61-0.70] and 0.78 [0.75-0.80], respectively.

Conclusions: One-quarter of DVT patients experienced PTS over 36-months after VTE diagnosis. Risk factors for severe PTS included: chronic heart failure, chronic immobilisation, prior VTE, and current smoking. The use of compression stockings was correlated with a reduction in severe PTS. Patient self-assessment proved feasible for estimating incident PTS over 36-months.

Variable	Odds Ratio [95% CI]	P-value
Compression stocking	0.50 [0.33, 0.76]	0.001
Smoking (ref: never)		0.003
Ex-smoker	0.61 [0.32, 1.19]
Current smoker	1.94 [1.20, 3.12]
Prior VTE	2.16 [1.36, 3.43]	0.001
Chronic heart failure	3.49 [1.50, 8.10]	0.003
Chronic immobilisation	2.50 [1.27, 4.89]	0.008

Selected variables for severe post-thrombotic syndrome multivariable model with odds ratios [95% confidence intervals] and p-values from Wald Chi-square test.

Calibration curve for predicted versus observed severe post-thrombotic syndrome

To cite this abstract in AMA style:

Prandoni P, Farjat AE, Haas S, Turpie AG, Bounameaux H, Schellong S, Goldhaber SZ, Kayani G, Carrier M, Jacobson B, Ageno W, Weitz JI, Goto S, Angchaisuksiri P, Mantovani LG, Kakkar AK. Incidence and Predictors of Post-thrombotic Syndrome: Results from GARFIELD-VTE [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/incidence-and-predictors-of-post-thrombotic-syndrome-results-from-garfield-vte/. Accessed November 29, 2023.

« Back to ISTH 2021 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/incidence-and-predictors-of-post-thrombotic-syndrome-results-from-garfield-vte/