Risk Factors of Severe Post-Thrombotic Syndrome in Young Patients from the North-West of Russia

Abstract

Introduction - Sever post-thrombotic syndrome (PTS) (CEAP4-6) is a complication of deep venous thrombosis leading to decreased quality of life. Вut what kind of predictors associated with the development of severe PTS is not fully identified. Methods - We retrospectively studied 120 young patients after acute DVT up to 45 years old (men − 57, women − 63, middle age − 37.4). For grading PTS, we used the clinical scale of chronic venous insufficiency (CEAP0-6). Sixty seven (55.8%) patients were genotyped for nine polymorphisms: factor I (FI) –455 G/A, FI Thr312Ala, FII 20210 G/A, FV 1691 G/A, FXII 46 C/T, FXIII Val34Leu, PAI-1 –675 4G/5G, TPA 311 bp I/D, EPCR Ser219Gly, that were discriminated by PCR-RFLP method. All results were analyzed with the SPSS software version 17.0 (SPSS Inc, Chicago, IL, USA). The differences in genotype distributions were estimated by Fisher’s exact test with calculating odds ratios (OR), their 95% confidence intervals (CI) and p-value. The discriminant analysis was used to define the predictors of severe PTS. Results - Severe PTS (CEAP4-6) was registered in 15 out of 67 genotyped patients (22.4%). The risk of severe PTS was increased dramatically in patients with established genetic risk factors, in particular, G20210A mutation (OR=4.3; 95%СI: 1.3-14.1; p=0.01), FV Leiden variant (OR=2.6; 95%СI: 0.9-7.1; p=0.05) and the homozygous FXIII 34Leu/Leu genotype (OR=6.9; 95%СI: 0.7-67.5; p=0.057). However, the discriminant analysis with inclusion of additional criteria (clinical and acquired) had shown that ipsilateral recurrence of DVT (p=0.05), obesity (p=0.002), varicose veins (p=0.07) and short courses of anticoagulant therapy (less than 3 months) (p=0.030) were associated with the risk of the sever PTS. None of studied DNA variations played a significant role in the outcome of DVT: FV 1691GA (p=0.160), FII 20210GA (p=0.501), FXIII 34Leu/Leu (p=0.141). Conclusion - Short courses of anticoagulant therapy is one of the most important risk factors of severe PTS in young patients.