Galanaud et al identified risk factors for post-thrombotic syndrome (PTS) following a first episode of deep vein thrombosis. This can help to identify patients who may benefit from additional preventive measures. The authors are from multiple hospitals in Canada, France and the United States.


Patient selection: first episode of unprovoked proximal deep vein thrombosis AND absence of primary venous insufficiency


Exclusion: moderate to severe venous ectasia in contralateral leg (evidence of primary venous insufficiency)


Outcome: post-thrombotic syndrome (PTS)


Key risk factors for PTS:

(1) obesity (body mass index >= 30 kg per square meter)

(2) mild venous unsufficiency (venous ectasia) in the contralateral leg


Additional factors that may contribute to the risk of PTS:

(1) poor INR control (based on percent of specimens with inadequate anti-coagulation, with INR <2)

(2) residual venous obstruction on baseline ultrasound (with wall thickening)


A patient with risk factors for the post-thrombotic syndrome should have preventive measures taken such as compressive stockings with confirmation of compliance. If poor INR control is an issue then this should be improved.


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