Advances in diagnosis, classification and management of lower extremity deep vein thrombosis (DVT), prevention of DVT recurrence and the post-thrombotic syndrome: personal experiences and appraisal of the literature
J. J. Michiels1,2, W. Moossdorff1, J. M. Michiels1,3, M. U. Lao1, H. Maasland1, H. Smeets1, M. Han1, P. Dulicek4, V. Stvrtinova4,5, Z. Pecsvarady4, P. Poredos4,6, A. Gadisseur7, W. Schroyens7 (1Rijnmond Rotterdam, Netherlands, 2Rotterdam, Netherlands, 3Rotterdam-Zuid Rotterdam, Netherlands, 4Prague, Czech Republic, 5Bratislava, Slovakia, 6Ljubljana, Slovenia, 7Antwerp, Belgium)
Time: 17:15 - 18:15
Results: Complete compression ultrasonography (CUS) followed by a sensitive D-dimer test and clinical score assessment is safe and cost-effective non-invasive strategy to exclude and diagnose deep vein thrombosis (DVT) and alternative diagnoses (AD) in patients with suspected DVT. Rapid and complete recanalization on CUS within 3 months post-DVT with no residual venous pathology (RVP-) is associated with low risk of DVT recurrence (1.2% patient/years) and PTS on the basis of which both anticoagulation MECS can be withdraw at 4 months post-DVT. Delayed and incomplete recanalization with RVP+ on CUS at 3 months post-DVT is associated with the presence of reflux due to valve destruction, a high risk of DVT recurrence and symptomatic PTS at 6 to 12 months post-DVT indicating the need to wear MECS and to extend anticoagulation for one to several years. Wearing MECS does not prevent DVT recurrence, reflux and outlet obstruction, but only relieves subjective signs in symptomatic PTS patients. Extended anticoagulation with low dose Direct Oral anticoagulants (DOACs) in patients at high risk of DVT recurrence will significantly reduce DVT recurrence and PTS. The Lower Extremity Thrombosis (LET) extension classification identifies patients with CVT LET class I, proximal DVT LET class II and iliofemoral DVT LET class III at time of acute DVT diagnosis. The higher the LET class the higher the risk of DVT recurrence and PTS. LET class II DVT patients do benefit from extended anticoagulation with DOACs. LET class III acute DVT patients do benefit from cathether-directed thrombolysis. A prospective safety efficacy outcome management study bridging the gap between DVT and PTS is warranted to reduce DVT recurrence rates to less than 3% patient/years during life long follow-up.