Inflammation in deep vein thrombosis and the development of post‐thrombotic syndrome: a prospective study

• Published in: Journal of thrombosis and haemostasis Vol. 7; no. 4; pp. 582 - 587
• Main Authors: ROUMEN‐KLAPPE, E. M., JANSSEN, M. C. H., VAN ROSSUM, J., HOLEWIJN, S., VAN BOKHOVEN, M. M. J. A., KAASJAGER, K., WOLLERSHEIM, H., DEN HEIJER, M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2009
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - blood; C‐reactive protein; deep vein thrombosis; Female; Humans; Inflammation - complications; interleukin‐6; Male; Middle Aged; Postthrombotic Syndrome - etiology; post‐thrombotic syndrome; Prospective Studies; Severity of Illness Index; Time Factors; Venous Insufficiency; venous outflow resistance; Venous Thrombosis - pathology
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/j.1538-7836.2009.03286.x

Background: The aim of this study was to investigate whether inflammatory markers (interleukin‐6 [IL‐6] and C‐reactive protein [CRP]) in the acute phase of deep vein thrombosis (DVT) are associated with elevated venous outflow resistance (VOR), thrombosis score (TS), reflux and the development of clinical post‐thrombotic syndrome (PTS). Methods: In 110 patients with a first DVT, plasma concentrations of IL‐6 and CRP were determined on the day of admission. VOR, TS and reflux were measured 7 days, 1 and 3 months after diagnosis. After 1 year patients were evaluated for PTS using the Clinical, Etiologic, Anatomic and Pathophysiologic (CEAP) classification and Villalta scale. Results: Median levels of IL‐6 and CRP were 7 pg mL−1 and 21 mg L−1, respectively. After 3 months, VOR was elevated in 33 patients (30%), TS in 33 (30%) and reflux in 57 (52%). Incidence of PTS was 36.7% using CEAP ≥ 3 and 35.4% using Villalta‐scale ≥ 5. Elevated levels of IL‐6 and CRP were related to higher outcomes of VOR after 3 months [relative risks (RR) 2.4 (95% CI 1.5–3.9) and 1.4 (1.1–3.3), respectively] and for IL‐6 to TS [1.5 (1.1–2.1)]. For reflux no relation was found. After 90 days, elevated outcomes of VOR, TS and reflux were related to PTS after 1 year. The association of IL‐6 and CRP with PTS was weak using the CEAP classification with a RR of 1.2 (0.7–2.2) and 1.8 (0.9–3.3) and absent according to the Villalta scale 0.6 (0.2–1.4) and 1.2 (0.6–2.5), respectively. Conclusion: The results of this study suggest that inflammation might play a role in incomplete thrombus clearance, venous outflow obstruction and the development of PTS after 1 year.