Background: The post-thrombotic syndrome (PTS) occurs in 30-40% of patients following deep vein thrombosis (DVT). Factors such as sex, older age, elevated body mass index (BMI) and ipsilateral prior DVT have previously been identified as strong predictors of PTS.

Aims: To investigate known and novel predictors of the development of PTS in participants of the ATTRACT Trial, which evaluated pharmacomechanical catheter-directed thrombolysis plus anticoagulation vs. anticoagulation alone to treat proximal DVT.

Methods: Using the ATTRACT Trial database, we used multivariate logistic regression to identify baseline and post-baseline factors that were predictive of the development of PTS during study follow-up, as defined by a Villalta score ≥5 from 6-24 months after enrolment.

Results: Among 691 study participants, median age was 53 years and 62% were male. In the multivariate analysis, age (OR 1.03 per year increase [95% CI 1.02 to 1.04]) and BMI (OR 1.05 per 1kg/m² [95% CI 1.02 to 1.07]) were independent predictors of PTS. Additional predictors identified were Villalta score at baseline (OR 1.09 per 1-unit increase [95% CI 1.05 to 1.13]), leg pain severity at day 10 (OR 1.28 [95% CI 1.13 to 1.45] per 1 point increase in a 7-point scale) and employment status (unemployed due to disability OR 3.31 [95% CI 1.72 to 6.35] vs. employed >35 hours per week). Use of rivaroxaban on day 10 appeared to be protective (OR 0.53 [95% CI 0.33 to 0.86]) when compared to warfarin.  

Conclusions: We confirmed that age and BMI were predictors of PTS in the ATTRACT population. We also identified that baseline Villalta score, leg pain severity at 10 days, and unemployed due to disability are independent predictors of PTS. Our findings also suggest that the initial choice of anticoagulant to treat DVT may have an impact on the development of PTS.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/predictors-of-the-development-of-the-post-thrombotic-syndrome-a-sub-analysis-of-the-attract-trial/