Abstract
Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT). Little is known about the involvement of adipokines in the pathogenesis of DVT. We evaluated whether adipokines can predict PTS. In a prospective cohort study, 320 DVT patients aged 70 years or less were enrolled. Serum adiponectin, leptin and resistin levels were measured three months since the index first-ever DVT. After 2 years’ follow-up PTS was diagnosed in 83 of 309 available patients (26.9%) who had 13.9% lower adiponectin and 16% higher leptin levels compared with the remainder (both p < 0.0001). No PTS-associated differences in C-reactive protein, fibrinogen, D-dimer, plasminogen activator inhibitor-1 and resistin were observed. The multivariable logistic regression adjusted for age, sex, obesity and tissue plasminogen activator (tPa) showed that lower adiponectin (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.31–0.56) and higher leptin levels (OR, 1.49; 95% CI, 1.31–1.69) are independent predictors for PTS. Obesity-stratified logistic regression analysis confirmed that lower adiponectin (OR, 0.49; 95% CI, 0.38–0.64) and higher leptin (OR, 1.41; 95% Cl, 1.25–1.58) levels predicted PTS. Our findings showed that lower adiponectin and higher leptin measured 3 months after DVT, regardless of obesity, can independently predict PTS, which suggests novel links between adipokines and thrombosis.
Highlights
Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT)[1], that manifests as pain, a sensation of swelling, cramps, heaviness, edema, redness and telangiectasia in the lower limbs[1,2]
This study is the first to show the association between adipokines and the development of PTS after a 2-years’ follow-up in a cohort of young and middle-aged DVT patients
We observed that elevated leptin and decreased adiponectin levels measured in one point time, 3 months since the first-ever DVT episode are independent predictors of PTS regardless of inflammatory state and obesity
Summary
Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT)[1], that manifests as pain, a sensation of swelling, cramps, heaviness, edema, redness and telangiectasia in the lower limbs[1,2]. A risk factor for PTS2,10,14,15, is associated with a pro-inflammatory and prothrombotic state[16,17]. The adipose tissue secretes several hormones and cytokines known as adipokines, including IL-6, tumor necrosis factor-alpha (TNF-α), leptin, adiponectin, plasminogen activator inhibitor 1 (PAI-1), resistin, and others[18,19]. Animal studies showed that leptin is associated with venous thrombosis and PE23, while adiponectin decreased platelet aggregation by promoting endothelial nitric oxide and attenuate oxidative/nitrative stress[24]. Given links of obesity to PTS2,10,14,15 and experimental data on the impact of adipokines on prothrombotic mechanisms in various models[21,22,23,24,25,26], we conducted a prospective cohort study to assess a predictive value of resistin, adiponectin and leptin in the PTS development
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