Predicting Post-Thrombotic Syndrome with Ultrasonographic Follow-Up after Deep Vein Thrombosis: A Systematic Review and Meta-Analysis

Thromb Haemost. 2018 Aug;118(8):1428-1438. doi: 10.1055/s-0038-1666859. Epub 2018 Jul 4.


Background: Post-thrombotic syndrome (PTS) is a common and potential severe complication of deep venous thrombosis (DVT). Elastic compression stocking therapy may prevent PTS if worn on a daily basis, but stockings are cumbersome to apply and uncomfortable to wear. Hence, identification of predictors of PTS may help physicians to select patients at high risk of PTS.

Aims: This article identifies ultrasonography (US) parameters assessed during or after treatment of DVT of the leg, that predict PTS.

Methods: This is a systematic review and meta-analysis study. Databases were searched for prospective studies including consecutive patients with DVT who received standardized treatment, had an US during follow-up assessing findings consistent with vascular damage after DVT and had a follow-up period of at least 6 months for the occurrence of PTS assessed by a standardized protocol.

Results: The literature search revealed 1,156 studies of which 1,068 were irrelevant after title and abstract screening by three independent reviewers. After full-text screening, 12 relevant studies were included, with a total of 2,684 analysed patients. Two US parameters proved to be predictive of PTS: residual vein thrombosis, for a pooled odds ratio (OR) of 2.17 (95% confidence interval [CI], 1.79-2.63) and venous reflux at the popliteal level, for a pooled OR of 1.34 (95% CI, 1.03-1.75).

Conclusion: The US features reflux and residual thrombosis measured at least 6 weeks after DVT predict PTS. Whether these features may be used to identify patients who may benefit from compression therapy remains to be assessed in further studies.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Clinical Decision-Making
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Postthrombotic Syndrome / etiology*
  • Postthrombotic Syndrome / prevention & control
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Stockings, Compression
  • Time Factors
  • Ultrasonography*
  • Venous Thrombosis / complications*
  • Venous Thrombosis / diagnostic imaging*
  • Venous Thrombosis / therapy