MARKERS OF COAGULATION AND INFLAMMATION IN RELATION TO THE POST THROMBOTIC SYNDROME
Authors: A.C. Bouman1, J.J.M. Smits1, H. ten Cate1, A.J. ten Cate-Hoek1
1: Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal medicine , Cardiovascular Research Institute Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
Introduction: Post thrombotic syndrome (PTS) occurs in 20-50% of patients after deep venous thrombosis (DVT). Although several risk factors for PTS are known, it is difficult to accurately predict which patients will develop PTS. Biomarkers could be a valuable tool for PTS risk assessment. Objective: To investigate whether increased levels of factor VIII, C-reactive protein (CRP) or D-dimer over time are associated with the development of PTS in 313 patients after acute DVT.
Methods: Data were derived from a prospective cohort study, PTS status was assessed using the Villalta scale. Blood sampling was performed at three points during follow-up: one month after discontinuation of anticoagulant treatment (T0) and at 12 (T1) and 24 (T2) months after index DVT.
Results: At T1 both levels of D-dimer (median 725 ng/ml (interquartile ranges 400-1400) versus 378 (251-652) p=0.004) and CRP (median 3.9 mg/l (interquartile ranges 1.6-8.5) versus 2.4 (1.0-4.3) p=0.018) were significantly increased in patients with PTS, compared to patients without PTS, respectively. FVIII was not associated with PTS. Univariate analysis demonstrated associations between PTS and several clinical characteristics. However, in the multivariate logistic regression analysis only varicosities (OR 13.4 95% CI 3.0-59.1 p=0.001), previous ipsilateral DVT (OR 6.3 95% CI 1.5-26.9 p=0.012), and CRP > 5 mg/l on T1 (OR 8.0 95% CI 2.4-26.4 p=0.001) remained significantly associated with PTS.
Conclusion: Besides previous ipsilateral DVT and varicosities, CRP > 5 mg/l at 1 year after the acute event of DVT was a strong and independent predictor for PTS. Persistent inflammation rather than hypercoagulability may be the most important etiological factor in PTS, and may be a target for future therapy. The development of a risk score for PTS, including both clinical risk factors and biomarker levels, might be desirable for the identification of patients prone to PTS.
Keywords: Post thrombotic syndrome, biomarkers, CRP, D-dimer , FVIII.
|
|||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||||||||||||||||||||||||||||||||||||
