OC 34.2 - Chronic inflammatory diseases increase the risk of post-thrombotic syndrome: a prospective cohort study

Monday, June 26, 2023

11:00 – 11:15 ET

Room: 520

Session Available As: On-Demand

Presenting Author(s)

Aaron F.J Iding, MD (he/him/his)

MD, PhD student
Thrombosis Expertise Center, Heart & Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands

Co-Author(s)

TL

Thibaut M.P. Limpens

Medical student
Maastricht University, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
Hugo ten Cate, MD, PhD, FAHA (he/him/his)

Professor, MD, PhD
Thrombosis Expertise Center, Heart & Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
At

Arina J. ten Cate-Hoek

Associate Professor, MD
Thrombosis Expertise Center, Heart & Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands

Background: Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT). Inflammation is known to play a major pathogenic role in PTS, possibly by promoting residual venous obstruction (RVO). Nevertheless, the potential impact of chronic inflammatory diseases (CIDs) and their anti-inflammatory treatment on the prevalence of PTS has not been studied thus far.

Aims: We assessed the risk of PTS in patients with CIDs, stratifying for anti-inflammatory treatment.

Methods: Consecutive patients with proximal DVT were followed prospectively for two years between 2003 and 2020. CIDs included inflammatory bowel disease, rheumatic diseases, and gout. Patients with active malignancy were excluded. RVO was assessed by compressive ultrasound after 3-6 months. PTS was diagnosed using the Villalta score after 6-24 months. Odds ratios (ORadj) were calculated by logistic regression adjusted for relevant patient characteristics. The medical ethics committee approved this study.

Results: In total 82 of 801 patients had CIDs (10.2%). Baseline characteristics were similar except for age (Table 1). RVO was more strongly associated with PTS in patients with CIDs (ORadj 4.22 [1.25-14.30]) compared to those without CIDs (ORadj 2.08 [1.37-3.15]). Overall, patients with CIDs had a similar prevalence of RVO (36.8 vs. 41.4%), but more often developed PTS (35.4% vs. 18.9%, p < 0.001) than those without CIDs (ORadj 2.37 [1.39-4.06]). In patients with CIDs that received anti-inflammatory treatment (n=46, 56%), the prevalence of RVO was much lower than in those with untreated CIDs (26.1% vs. 53.3%, p=0.027). Accordingly, the risk of PTS was particularly high in patients with untreated CIDs (ORadj 3.56 [1.70-7.43]) compared to those without CIDs (Figure 1).

Conclusion(s): Patients with CIDs were at an increased risk to develop PTS. Notably, the risk of PTS was lower in patients with treated CIDs, which might be due to a favorable effect of anti-inflammatory treatment on RVO-related venous pathology.

Learning Objectives:

Upon completion, participants will appreciate the importance of chronic inflammatory diseases in determining the long-term outcomes of patients with deep vein thrombosis of the lower extremity.
Upon completion, participants will consider chronic inflammatory diseases as a risk factor of not only recurrent venous thromboembolism, but also post-thrombotic syndrome, which might have a very different underlying mechanism.
Upon completion, participants will understand that there could be a role for residual venous obstruction and anti-inflammatory treatment in the risk of post-thrombotic syndrome for patients with chronic inflammatory diseases.