SearchThe Long-Term Complications of VTE
Once VTE develops, the risk of recurrence is high
In addition to the acute risk of pulmonary embolism (PE), a potentially life-threatening event, venous thrombosis also poses risks of intermediate- and long-term complications that include recurrent deep vein thrombosis (DVT), post-thrombotic syndrome (PTS), and chronic thromboembolic pulmonary hypertension (CTEPH).
The risk of recurrent DVT
The optimal treatment for patients at high risk of DVT is preventive therapy.3 The risk of recurrent DVT varies depending on the initial treatment. With no treatment, about half of the patients with symptomatic proximal DVT or PE experience a recurrence within three months.73 Inadequate treatment of proximal DVT lowers the recurrence rate to about 40%.43 When proximal DVT is treated with the standard three-month course of effective anticoagulation, the recurrence rate decreases considerably, to 4%. Symptomatic DVT in the calf requires a comparable duration of anticoagulant therapy. In one study, patients treated with an initial five-day course of heparin but no follow-up oral anticoagulation had a risk of recurrence greater than 20% over three months.43, 73
The risk of post-thrombotic syndrome
Between 20% and 50% of those who develop DVT eventually develop a condition known as post-thrombotic syndrome (PTS).74 The exact cause of PTS is not well understood, but it may involve damage to venous valves, ultimately leading to increased intravenous pressure.75 The main symptom is chronic pain. Signs of PTS include swelling, discolouration of the affected leg, and, in severe cases, skin ulceration. In addition to pain, patients with PTS may experience a sensation of heaviness, as well as cramps, itching, and tingling.74
PTS is not reliably prevented by prompt antithrombotic therapy following the diagnosis of DVT. This is another reason why preventive therapy is the optimal approach for high-risk patients.76
PTS is not reliably prevented by prompt antithrombotic therapy following the diagnosis of DVT. This is another reason why preventive therapy is the optimal approach for high-risk patients.76
The risk of chronic thromboembolic pulmonary hypertension (CTEPH)
Pulmonary hypertension — chronically elevated blood pressure in the pulmonary circulation — occurs as a late complication in between 3% and 4% of patients who survive pulmonary embolism.77
Symptoms include progressive shortness of breath and exercise intolerance. Later in the course of the disorder, chest pain with exertion and syncope may occur. Without intervention, the five-year survival rate once the mean pulmonary artery pressure reaches 40 mm Hg is about 30%.78
Symptoms include progressive shortness of breath and exercise intolerance. Later in the course of the disorder, chest pain with exertion and syncope may occur. Without intervention, the five-year survival rate once the mean pulmonary artery pressure reaches 40 mm Hg is about 30%.78
- 3 - Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, and Colwell CW. Prevention of Venous Thromboembolism: American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. Jun 2008: 381S–453S.
- 73 - Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 suppl 1):I22-I30.
- 43 - Kearon C, Hirsh J. Cardiovascular medicine: XVIII. Venous thromboembolism. In: Dale DC, ed. ACP Medicine. New York, NY: WebMD, Inc; 2007:1-15. Available at http://www.acpmedicine.com/acp_home.htm. Accessed February 12, 2008.
- 74 - Kahn SR. The post-thrombotic syndrome: the forgotten morbidity of deep venous thrombosis. J Thromb Thrombolysis. 2006;21(1):41-48.
- 75 - Haenen JH, Janssen MC, van Langen H, et al. The postthrombotic syndrome in relation to venous hemodynamics, as measured by means of duplex scanning and strain-gauge plethysmography. J Vasc Surg. 1999;29(6):1071-1076.
- 76 - Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125(1):1-7.
- 77 - Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350(22):2257-2264.
- 78 - Fedullo PF, Auger WR, Kerr KM, Rubin LJ. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2001;345(20):1465-1472.
- Hypertension
- Persistently high arterial blood pressure. Hypertension may have no known cause (essential or idiopathic hypertension) or be associated with other primary diseases (secondary hypertension). This condition is considered a risk factor for the development of heart disease, peripheral vascular disease, stroke, and kidney disease.
- Post-thrombotic syndrome
- A syndrome that can follow a vascular thrombosis. Clinical signs and symptoms of this syndrome include chronic pain, swelling, oedema, discolouration, and in severe cases, venous ulceration. It is likely that valvular incompetence is associated with the clinical manifestations of post-thrombotic syndrome.
- Heparin
- An anticoagulant that exerts its activity by binding to antithrombin and greatly increasing its activity. The principal coagulation factors inhibited by heparin are Factors IIa and Xa. It is administered by intravenous or subcutaneous injection.
- Intravenous
- Administration of liquid substances directly into the venous part of the bloodstream.
