ABSTRACT
The post thrombotic syndrome (PTS) is the most common chronic complication of deep vein thrombosis (DVT), with a cumulative incidence of 20-50%. PTS is characterized by the occurrence of various signs and symptoms of chronic venous insufficiency in a limb previously affected by DVT. This condition significantly impairs quality of life and results in substantial burden to society. So far, treatment options are limited and strategies that prevent PTS occurrence are therefore of major importance. The present article critically reviews the definition, diagnosis, incidence, risk factors of PTS occurrence and treatment strategies for PTS.
Subject(s)
Postthrombotic Syndrome/etiology , Venous Thromboembolism/complications , Humans , Postthrombotic Syndrome/therapyABSTRACT
BACKGROUND: Few studies have evaluated the long-term economic consequences of deep vein thrombosis (DVT). None of them have incorporated prospectively collected clinical data to ensure accurate identification of incident cases of DVT and DVT-related health outcomes of interest, such as post-thrombotic syndrome (PTS). OBJECTIVES: To prospectively quantify medical and non-medical resource use and costs related to DVT during 2 years following diagnosis, and to identify clinical determinants of costs. METHODS: Three hundred and fifty-five consecutive patients with acute DVT were recruited at seven Canadian hospital centers. Resource use and cost information were retrieved from three sources: weekly patient-completed cost diaries, nurse-completed case report forms, and the Quebec provincial administrative healthcare database (RAMQ). RESULTS: The rate of DVT-related hospitalization was 3.5 per 100 patient-years (95% confidence interval [CI] 2.2-4.9). Patients reported a mean (standard deviation) of 15.0 (14.5) physician visits and 0.7 (1.2) other healthcare professional visits. The average cost of DVT was $5180 (95% CI $4344-6017) in Canadian dollars, with 51.6% of costs being attributable to non-medical resource use. Multivariate analysis identified four independent predictors of costs: concomitant pulmonary embolism (relative increase in cost [RIC] 3.16; 95% CI 2.18-4.58), unprovoked DVT (RIC 1.65; 95% CI 1.28-2.13), development of PTS during follow-up (RIC 1.35; 95% CI 1.05-1.74), and management of DVT in the inpatient setting (RIC 1.79; 95% CI 1.33-2.40). CONCLUSIONS: The economic burden of DVT is substantial. The use of measures to prevent the occurrence of PTS and favoring outpatient care of DVT has the potential to diminish costs.
Subject(s)
Cost of Illness , Venous Thrombosis/economics , Adult , Aged , Canada , Female , Health Care Rationing , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
The optimal duration of oral anticoagulation therapy for venous thromboembolism is controversial. Recent studies focused on identifying risk factors associated with recurrent thromboembolism in order to identify patients at particularly high risk for recurrence and optimize the duration of anticoagulant treatment. Recent studies show that an elevated D-dimer level one month after stopping the initial course of anticoagulants is associated with higher risk of recurrence. Despite theses results, evidence of using D-dimer for tailoring duration of anticoagulation is still sparse.
