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Thromb Haemost. 2018 Feb;118(2):320-328. doi: 10.1160/TH17-08-0598. Epub 2018 Jan 29.

Predictors of Post-Thrombotic Ulcer after Acute DVT: The RIETE Registry.

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Department of Internal Medicine and Clinical Investigation Centre, Montpellier University Hospital, Montpellier University, Montpellier, France.
Department of General Internal Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
Department of Vascular Medicine, Saint Etienne University Hospital, Saint Etienne, France.
Department of General Medicine, Azienda Ospedaliera S. G. Moscatti Hospital, Avellino, Italy.
Department of Internal Medicine, La Paz University Hospital, Madrid, Spain.
Department of Internal Medicine, San Carlos University Hospital, Madrid, Spain.
Department of Internal Medicine, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, Spain.
Department of Pneumology, San Pedro Hospital, Logrono, Spain.
Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.
Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain.
Department of Medicine, McGill University and Centre for Clinical Epidemiology, Jewish; General Hospital, Montreal, Canada.
Department of Clinical Medicine, University of Padua, Padua, Italy.
Department of Internal Medicine, Hospital De Badalona Germans Trias I Pujol, Universidad Católica De Murcia, Spain.


In patients with deep-vein thrombosis (DVT) in the lower limbs, venous ulcer is the most debilitating and end-stage clinical expression of the post-thrombotic syndrome (PTS). To date, risk factors for PTS-related ulcer in DVT patients have not been identified.We used the international observational RIETE registry to assess the evolution of PTS signs and symptoms during a 3-year follow-up period and to identify independent predictors of PTS ulcer at 1 year in patients with acute DVT.Among 1,866 eligible patients, cumulative rates of PTS ulcer at 1, 2 and 3 years were 2.7% (n = 50), 4.3% (n = 54) and 7.1% (n = 60), respectively. The proportion of patients with PTS symptoms at 1, 2 or 3 years remained stable (≈40%), while the proportion of patients with PTS signs increased slightly over time (from 49 to 53%). Prior history of venous thromboembolism (VTE) (odds ratio [OR] = 5.5 [2.8-10.9]), diabetes (OR = 2.3 [1.1-4.7]), pre-existing leg varicosities (OR = 3.2 [1.7-6.1]) and male sex (OR = 2.5 [1.3-5.1]) independently increased the risk of PTS ulcer at 1 year. Obesity also increased the risk but failed to reach statistical significance (OR = 1.8 [0.9-3.3]). DVT treatment characteristics (duration or drug) did not influence the risk.Our results evidence that after acute DVT, pre-existing leg varicosities, prior venous thromboembolism, diabetes and male gender independently increased the risk for PTS ulcer. This suggests that clinicians should consider strategies aimed to prevent ulcers in high-risk DVT patients, such as preventing VTE recurrence, use of stockings in those with pre-existing venous insufficiency, careful monitoring of diabetic patients and encouraging weight loss in obese patients.


Conflict of interest statement

Authors state that they have no conflict of interest. They all had access to the data and had a role in writing the manuscript.

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