SlideShare a Scribd company logo
The predictive factorsThe predictive factors
inin
PTS developmentPTS development
Alexandru Andritoiu
Cristian Silosi
Military Hospital Craiova
IntroductionIntroduction
• PTS is the most frequent complication of a DVT
• it occurs in 20-50% of pts. with a DVT
• PTS is associated with important morbidity
• The development of PTS was the strongest
predictor of quality of life within the first 2
years of the diagnosis of a DVT
• PTS also markedly increases health care costs
Risk factors for PTS
• proximal DVT (ilio-femoral DVT)
• ipsilateral recurrence of DVT
• poor quality of anticoagulation
• lack of resolution of DVT symptoms and signs
• unprovochet DVT
• advanced age
• increased BMI
Predictors of PTS are still poorly understood!
The ability to predict which patients with DVT are likely to
develop PTS, and severe PTS, is poor!
Characteristics associated with PTS
• Recurrent VTE (OR 2.5 95% CI 1.1–5.8 P = 0.030);
• Previous VTE (OR 2.6 95% CI 1.3–5.5 P = 0.008);
• Previous ipsilateral DVT (OR 4.2 95% CI 1.6–10.9 P = 0.002);
• Varicosities (OR 6.7 95% CI 2.7–16.9 P = 0.000);
• Venous insufficiency (without varicosities) (OR 4.5 95%
CI 0.9–23.2 P = 0.05);
• CRP above cut-off of 5 mg L−1 on 12Mo (OR 3.0 95% CI
1.3–7.3 P = 0.011).
• This is in contrast with provoked DVT (OR 0.5 95% CI
0.2–1.0 P = 0.043), which appeared to reduce the risk of
developing PTS
The key players in PTS pathogenesis
• Inflammation
• Coagulation-fibrinolysis
• Impaired thrombus resolution
• Unapropriate anticoagulation
• Chronic venous hypertension
• Endothelial dysfunction
Inflammation and PTSInflammation and PTS
J Thromb Haemost 2015; 13: 398–408.
Inflammation after DVT appears to play a role in PTS development,
and ICAM-1 could prove to be a predictor of PTS
Inflammation in deep vein thrombosis and the
development of post-thrombotic syndrome:
A prospective study
110 pts TVP (evaluati la 12 luni pr SPT)
IL-6
CRP
• Rezultatele acestui studiu sugereaza ca
inflamatia ar putea juca un rol in
clearance-ul incomplet al trombusului,
persistenta obstructiei venoase si aparitia
dupa 1 an a SPT.
Klappe E et al. J of Thrombosis and Haemostasis 2009;7(4):582-587
Objectives: To investigate whether increased levels of factor
(F)VIII, C-reactive protein (CRP) or D-dimer, over time, are
associated with the development of PTS in patients after an acute
DVT.
Conclusions: Besides previous ipsilateral DVT and varicosities, CRP > 5
mgL at 12 months was strongly and independently associated with PTS.
Persistent inflammation rather than hypercoagulability might be the
most important etiological factor in PTS
Levels of C-reactive protein (CRP) by PTS status
Bouman AC et al. JHT 2012
Inflammatory biomarkers and PTS
• CRP
• IL-6
• IL-8
• IL-10
• ICAM-1
• VCAM-1
• MMP-9
• P-selectin
• TNF-alfa
• ESR
• ICAM-1 was significantly
associated with PTS
• Other biomarkers did not
demonstrate a significant
association with PTS.
Rabinovich A, Cohen JM, Kahn SR. Thromb Res 2015
Biomarkers could be a valuable tool for PTS risk assessment
Coagulation-fibrinolysisCoagulation-fibrinolysis
Markers of fibrinolysis and endothelial
dysfunction in PTS
• D-dimers
• Fibrinogen
• von Willebrand F
• PAI-1
• F XIII activity
• Hemophylia
A significant association with PTS was found for D-dimer in studies
Rabinovich A, Cohen JM, Kahn SR. JTH 2014
D-dimer level significantly predicted PTS (P = 0.03)
Measurement of D-dimer 4 months after DVT may help predict which patients
are at higher risk of developing PTS and who thus may be more likely to
benefit from preventive strategies such as compression stockings for PTS.
Venous valvular reflux was found to be strongly associated with
moderate-to-severe PTS.
Levels of D-dimer by PTS status
Bouman AC et al. JHT 2012
Results: During a 1-year follow-up PTS developed in 48 (24%)
patients, who were characterized by lower Ks, prolonged fibrin clot
lysis time (CLT) and slower release of D-dimer from clots (D–Drate),
together with higher plasma D-dimer, C-reactive protein and
thrombin-activatable fibrinolysis inhibitor (TAFI)
Our study provides evidence that denser fibrin clot formation and
impaired lysis may allow the identification of patients who are likely
to develop PTS
following DVT.
UnapropriateUnapropriate
anticoagulationanticoagulation
Conclusion:
Subtherapeutic warfarin anticoagulation after a first
unprovoked DVT was significantly associated with the
development of PTS.
Impaired thrombus resolutionImpaired thrombus resolution
Residual thrombosis
• a lack of recanalization within the first
six months after the thrombotic
episode appears to be an important
predictor of PTS.
• incompetence of the popliteal valve
increases the risk of the PTS when
combined with residual vein thrombosis.
Roumen-Klappe et al. J Thromb Haemost 2005
PTS (ex)PTS (ex)
Colectia Dr. A. Andritoiu
Case-ReportCase-Report
TVP ilio-femuralaTVP ilio-femurala
S. Mirel, 42 aniS. Mirel, 42 ani
• TVP idiopatica stg.
• Ileo-Fem-Pop
• CT
• VSH 71 mm/h
• CRP 7.7 mg/dL
• Fibrinogen 622 mg/dL
• Leuc 10.200/mmc
• Fara semne de
inflamatie locala
Case-Report 2Case-Report 2
TVP v. popliteeTVP v. poplitee
N. Simona, 32 ani
• TVP acuta
(idiopatica)-10 z
• V poplitee stg.
• CDUS
• VSH 30 mm/h
• Fibrinogen 202 mg/dL
• CRP 1.1 mg/dL
• Leuc 8.300/mmc
In care caz riscul aparitiei SPTIn care caz riscul aparitiei SPT
este mai mare?este mai mare?
Raspuns corect: Cazul 1Raspuns corect: Cazul 1
Argumente:
• Localizare proximala
• Volum mare al trombusului
• TV idiopatica
• Raspuns slab la AVK (trombus masiv la INR 4.4)
• Probe inflamatorii (+++)
Thrombophilia and the PTS
Association between Thrombophilia
and the PTS
• the various thrombophilias are important risk
factors for VTE, and PTS is a frequent
complication of VTE, especially after recurrent
DVT.
• directly by prolonging residual venous
thrombosis
• indirectly by increasing venous thrombotic
recurrence rate.
• Our meta-analysis did not demonstrate a
significant association between any of the
thrombophilias and PTS
Rabinovich A, Kahn SR. Intern J Vasc Med 2013
The thrombus burdenThe thrombus burden
The Thrombus burden
• Proximal DVT is associated with a higher frequency
and more severe PTS than distal DVT
• PTS syndrome occurs more frequently when venous
thrombosis is extensive or affects proximal veins,
popliteal, and calf veins.
• Superficial veins involvement is also commonly
associated with the development of PTS.
Kreidy R- Vascular Medicine 2011
CONCLUSIONSCONCLUSIONS
1821-1902
The elements comprising Virchow's triad were
neither proposed by Virchow, nor did he ever
suggest a triad to describe the pathogenesis of
venous thrombosis

More Related Content

What's hot

Γρηγόριος Γεροτζιάφας, 4th Health Innovation Conference
Γρηγόριος Γεροτζιάφας, 4th Health Innovation ConferenceΓρηγόριος Γεροτζιάφας, 4th Health Innovation Conference
Γρηγόριος Γεροτζιάφας, 4th Health Innovation Conference
Starttech Ventures
 
steroid resistant nephrotic syndrome
steroid resistant nephrotic syndromesteroid resistant nephrotic syndrome
steroid resistant nephrotic syndrome
Pediatric Nephrology
 
Hivan
HivanHivan
Hiv associated nephropathy(Dr. sood)
Hiv associated nephropathy(Dr. sood)Hiv associated nephropathy(Dr. sood)
Hiv associated nephropathy(Dr. sood)
polobismuth
 
Renal Disease in HIV/AIDS
Renal Disease in HIV/AIDSRenal Disease in HIV/AIDS
Renal Disease in HIV/AIDS
UC San Diego AntiViral Research Center
 
renal involvement in children with covid19
renal involvement in children with covid19renal involvement in children with covid19
renal involvement in children with covid19
Pediatric Nephrology
 
Lupus Nephritis In Children
Lupus Nephritis In ChildrenLupus Nephritis In Children
Lupus Nephritis In Children
Dang Thanh Tuan
 
case microscopic polyangiitis
case microscopic polyangiitiscase microscopic polyangiitis
case microscopic polyangiitis
Prachya Bung
 
Comparative Study of Hscrp in Chronic Kidney Disease
Comparative Study of Hscrp in Chronic Kidney DiseaseComparative Study of Hscrp in Chronic Kidney Disease
Comparative Study of Hscrp in Chronic Kidney Disease
iosrphr_editor
 
HCV in CKD
HCV in CKDHCV in CKD
HCV in CKD
Pratap Tiwari
 
Pneumocystis carinii
Pneumocystis cariniiPneumocystis carinii
Pneumocystis carinii
Katsushige Takagishi
 
Eosinophilic granulomatosis with polyangitis
Eosinophilic granulomatosis with polyangitisEosinophilic granulomatosis with polyangitis
Eosinophilic granulomatosis with polyangitis
Marwa Besar
 
Nefropatia asociada al hiv
Nefropatia asociada al hivNefropatia asociada al hiv
Nefropatia asociada al hiv
Oscar Malpartida-Tabuchi
 
Granulomatosis polyangitis GPA
Granulomatosis polyangitis GPAGranulomatosis polyangitis GPA
Granulomatosis polyangitis GPA
Marwa Besar
 
Caso clinico. apendicitis y lma
Caso clinico. apendicitis y lmaCaso clinico. apendicitis y lma
Caso clinico. apendicitis y lma
Maira Castaño
 
ANCA vasculitis and Renal Diseases
ANCA vasculitis and Renal DiseasesANCA vasculitis and Renal Diseases
ANCA vasculitis and Renal Diseases
Malsawmkima Chhakchhuak
 
Debate: Goal directed vs Ratio-based Transfusion.
Debate: Goal directed vs Ratio-based Transfusion.Debate: Goal directed vs Ratio-based Transfusion.
Debate: Goal directed vs Ratio-based Transfusion.
CICM 2019 Annual Scientific Meeting
 
Hiv associated nephropathy (hivan)
Hiv associated nephropathy (hivan)Hiv associated nephropathy (hivan)
Hiv associated nephropathy (hivan)
carol dzorani
 
Beyond amyloidosis a case of cardiac light chain deposition disease
Beyond amyloidosis a case of cardiac light chain deposition diseaseBeyond amyloidosis a case of cardiac light chain deposition disease
Beyond amyloidosis a case of cardiac light chain deposition disease
drucsamal
 

What's hot (19)

Γρηγόριος Γεροτζιάφας, 4th Health Innovation Conference
Γρηγόριος Γεροτζιάφας, 4th Health Innovation ConferenceΓρηγόριος Γεροτζιάφας, 4th Health Innovation Conference
Γρηγόριος Γεροτζιάφας, 4th Health Innovation Conference
 
steroid resistant nephrotic syndrome
steroid resistant nephrotic syndromesteroid resistant nephrotic syndrome
steroid resistant nephrotic syndrome
 
Hivan
HivanHivan
Hivan
 
Hiv associated nephropathy(Dr. sood)
Hiv associated nephropathy(Dr. sood)Hiv associated nephropathy(Dr. sood)
Hiv associated nephropathy(Dr. sood)
 
Renal Disease in HIV/AIDS
Renal Disease in HIV/AIDSRenal Disease in HIV/AIDS
Renal Disease in HIV/AIDS
 
renal involvement in children with covid19
renal involvement in children with covid19renal involvement in children with covid19
renal involvement in children with covid19
 
Lupus Nephritis In Children
Lupus Nephritis In ChildrenLupus Nephritis In Children
Lupus Nephritis In Children
 
case microscopic polyangiitis
case microscopic polyangiitiscase microscopic polyangiitis
case microscopic polyangiitis
 
Comparative Study of Hscrp in Chronic Kidney Disease
Comparative Study of Hscrp in Chronic Kidney DiseaseComparative Study of Hscrp in Chronic Kidney Disease
Comparative Study of Hscrp in Chronic Kidney Disease
 
HCV in CKD
HCV in CKDHCV in CKD
HCV in CKD
 
Pneumocystis carinii
Pneumocystis cariniiPneumocystis carinii
Pneumocystis carinii
 
Eosinophilic granulomatosis with polyangitis
Eosinophilic granulomatosis with polyangitisEosinophilic granulomatosis with polyangitis
Eosinophilic granulomatosis with polyangitis
 
Nefropatia asociada al hiv
Nefropatia asociada al hivNefropatia asociada al hiv
Nefropatia asociada al hiv
 
Granulomatosis polyangitis GPA
Granulomatosis polyangitis GPAGranulomatosis polyangitis GPA
Granulomatosis polyangitis GPA
 
Caso clinico. apendicitis y lma
Caso clinico. apendicitis y lmaCaso clinico. apendicitis y lma
Caso clinico. apendicitis y lma
 
ANCA vasculitis and Renal Diseases
ANCA vasculitis and Renal DiseasesANCA vasculitis and Renal Diseases
ANCA vasculitis and Renal Diseases
 
Debate: Goal directed vs Ratio-based Transfusion.
Debate: Goal directed vs Ratio-based Transfusion.Debate: Goal directed vs Ratio-based Transfusion.
Debate: Goal directed vs Ratio-based Transfusion.
 
Hiv associated nephropathy (hivan)
Hiv associated nephropathy (hivan)Hiv associated nephropathy (hivan)
Hiv associated nephropathy (hivan)
 
Beyond amyloidosis a case of cardiac light chain deposition disease
Beyond amyloidosis a case of cardiac light chain deposition diseaseBeyond amyloidosis a case of cardiac light chain deposition disease
Beyond amyloidosis a case of cardiac light chain deposition disease
 

Similar to The predictive biomarkers in pts development

Serum Procalcitonin as a marker of infection in chronic kidney disease patien...
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...Serum Procalcitonin as a marker of infection in chronic kidney disease patien...
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...
iosrjce
 
1 prevalencia tep covid abril 2020
1 prevalencia tep covid abril 20201 prevalencia tep covid abril 2020
1 prevalencia tep covid abril 2020
Freddy Flores Malpartida
 
Iliofemoral DVT thrombolysis
Iliofemoral DVT thrombolysisIliofemoral DVT thrombolysis
Iliofemoral DVT thrombolysis
SpecialistVeinHealth
 
Inflamatia in TVP
Inflamatia in TVPInflamatia in TVP
Inflamatia in TVP
ALEXANDRU ANDRITOIU
 
Pulmonary embolism
Pulmonary embolismPulmonary embolism
Pulmonary embolism
Mostafa Elshazly
 
Anaesthesia for septic patient
Anaesthesia for septic patientAnaesthesia for septic patient
Anaesthesia for septic patient
Arun Gupta
 
Acute pulmonary thromboembolism
Acute pulmonary thromboembolismAcute pulmonary thromboembolism
Acute pulmonary thromboembolism
Dr. Mohammed Sadiq Azam M.D.
 
dvt prophylaxis, in icu, deep venous thrombosis prophylaxis ,
dvt prophylaxis, in icu, deep venous thrombosis prophylaxis ,dvt prophylaxis, in icu, deep venous thrombosis prophylaxis ,
dvt prophylaxis, in icu, deep venous thrombosis prophylaxis ,
gagan brar
 
Dic Dr Umashankar
Dic Dr UmashankarDic Dr Umashankar
Dic Dr Umashankar
Umashankar U S
 
Membranous Nephropathy
Membranous NephropathyMembranous Nephropathy
Membranous Nephropathy
edwinchowyw
 
Covid 19 & Hypercoagulability
Covid 19 & HypercoagulabilityCovid 19 & Hypercoagulability
Covid 19 & Hypercoagulability
Monkez M Yousif
 
1320 1340 Venothromboembolic Diseases AGupta FINAL (1).pptx
1320 1340 Venothromboembolic Diseases AGupta FINAL (1).pptx1320 1340 Venothromboembolic Diseases AGupta FINAL (1).pptx
1320 1340 Venothromboembolic Diseases AGupta FINAL (1).pptx
OmarHussain55
 
VTE.pdf
VTE.pdfVTE.pdf
Acute pancreatitis
Acute pancreatitisAcute pancreatitis
Acute pancreatitis
Apollo Hospitals
 
poster presentation Study of hematological parameters in sepsis patients and...
 poster presentation Study of hematological parameters in sepsis patients and... poster presentation Study of hematological parameters in sepsis patients and...
poster presentation Study of hematological parameters in sepsis patients and...
RahulGupta1687
 
Polyarteritis nodosa
Polyarteritis nodosaPolyarteritis nodosa
Polyarteritis nodosa
ucrheumatologyfellowship
 
Pulmonary embolism
Pulmonary embolismPulmonary embolism
Pulmonary embolism
Dr. Rohan Sonawane
 
article 4.pdf about CAP pneumonia community
article 4.pdf about CAP pneumonia communityarticle 4.pdf about CAP pneumonia community
article 4.pdf about CAP pneumonia community
sakirhrkrj
 
Monitoring the Multiple Sclerosis patient
Monitoring the Multiple Sclerosis patientMonitoring the Multiple Sclerosis patient
Monitoring the Multiple Sclerosis patient
Pramod Krishnan
 
Pulmonary embolism
Pulmonary embolismPulmonary embolism
Pulmonary embolism
DosSantosh
 

Similar to The predictive biomarkers in pts development (20)

Serum Procalcitonin as a marker of infection in chronic kidney disease patien...
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...Serum Procalcitonin as a marker of infection in chronic kidney disease patien...
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...
 
1 prevalencia tep covid abril 2020
1 prevalencia tep covid abril 20201 prevalencia tep covid abril 2020
1 prevalencia tep covid abril 2020
 
Iliofemoral DVT thrombolysis
Iliofemoral DVT thrombolysisIliofemoral DVT thrombolysis
Iliofemoral DVT thrombolysis
 
Inflamatia in TVP
Inflamatia in TVPInflamatia in TVP
Inflamatia in TVP
 
Pulmonary embolism
Pulmonary embolismPulmonary embolism
Pulmonary embolism
 
Anaesthesia for septic patient
Anaesthesia for septic patientAnaesthesia for septic patient
Anaesthesia for septic patient
 
Acute pulmonary thromboembolism
Acute pulmonary thromboembolismAcute pulmonary thromboembolism
Acute pulmonary thromboembolism
 
dvt prophylaxis, in icu, deep venous thrombosis prophylaxis ,
dvt prophylaxis, in icu, deep venous thrombosis prophylaxis ,dvt prophylaxis, in icu, deep venous thrombosis prophylaxis ,
dvt prophylaxis, in icu, deep venous thrombosis prophylaxis ,
 
Dic Dr Umashankar
Dic Dr UmashankarDic Dr Umashankar
Dic Dr Umashankar
 
Membranous Nephropathy
Membranous NephropathyMembranous Nephropathy
Membranous Nephropathy
 
Covid 19 & Hypercoagulability
Covid 19 & HypercoagulabilityCovid 19 & Hypercoagulability
Covid 19 & Hypercoagulability
 
1320 1340 Venothromboembolic Diseases AGupta FINAL (1).pptx
1320 1340 Venothromboembolic Diseases AGupta FINAL (1).pptx1320 1340 Venothromboembolic Diseases AGupta FINAL (1).pptx
1320 1340 Venothromboembolic Diseases AGupta FINAL (1).pptx
 
VTE.pdf
VTE.pdfVTE.pdf
VTE.pdf
 
Acute pancreatitis
Acute pancreatitisAcute pancreatitis
Acute pancreatitis
 
poster presentation Study of hematological parameters in sepsis patients and...
 poster presentation Study of hematological parameters in sepsis patients and... poster presentation Study of hematological parameters in sepsis patients and...
poster presentation Study of hematological parameters in sepsis patients and...
 
Polyarteritis nodosa
Polyarteritis nodosaPolyarteritis nodosa
Polyarteritis nodosa
 
Pulmonary embolism
Pulmonary embolismPulmonary embolism
Pulmonary embolism
 
article 4.pdf about CAP pneumonia community
article 4.pdf about CAP pneumonia communityarticle 4.pdf about CAP pneumonia community
article 4.pdf about CAP pneumonia community
 
Monitoring the Multiple Sclerosis patient
Monitoring the Multiple Sclerosis patientMonitoring the Multiple Sclerosis patient
Monitoring the Multiple Sclerosis patient
 
Pulmonary embolism
Pulmonary embolismPulmonary embolism
Pulmonary embolism
 

More from ALEXANDRU ANDRITOIU

Occult cancer screening in thromboembolic disease
Occult cancer screening in thromboembolic diseaseOccult cancer screening in thromboembolic disease
Occult cancer screening in thromboembolic disease
ALEXANDRU ANDRITOIU
 
Carotid atherosclerosis in patients with PAD
Carotid atherosclerosis in patients with PADCarotid atherosclerosis in patients with PAD
Carotid atherosclerosis in patients with PAD
ALEXANDRU ANDRITOIU
 
PULSATILE VENOUS FLOW IN LEGS
PULSATILE VENOUS FLOW IN LEGSPULSATILE VENOUS FLOW IN LEGS
PULSATILE VENOUS FLOW IN LEGS
ALEXANDRU ANDRITOIU
 
PPG and CDUS in venous reflux disease
PPG and CDUS in venous reflux diseasePPG and CDUS in venous reflux disease
PPG and CDUS in venous reflux disease
ALEXANDRU ANDRITOIU
 
Abces de iliopsoas
Abces de iliopsoasAbces de iliopsoas
Abces de iliopsoas
ALEXANDRU ANDRITOIU
 
Occlusion and near occlusion of carotid arteries
Occlusion and near occlusion of carotid arteriesOcclusion and near occlusion of carotid arteries
Occlusion and near occlusion of carotid arteries
ALEXANDRU ANDRITOIU
 
Elastografia in tvp
Elastografia in tvpElastografia in tvp
Elastografia in tvp
ALEXANDRU ANDRITOIU
 
Rolul us in ablatia v
Rolul us in ablatia vRolul us in ablatia v
Rolul us in ablatia v
ALEXANDRU ANDRITOIU
 
Abordarea holistica in patologia venoasa
Abordarea holistica in patologia venoasaAbordarea holistica in patologia venoasa
Abordarea holistica in patologia venoasa
ALEXANDRU ANDRITOIU
 
Aderenta si riscul cardiovascul
Aderenta si riscul cardiovasculAderenta si riscul cardiovascul
Aderenta si riscul cardiovascul
ALEXANDRU ANDRITOIU
 
Indicele de rezistenta carotidian
Indicele de rezistenta carotidianIndicele de rezistenta carotidian
Indicele de rezistenta carotidian
ALEXANDRU ANDRITOIU
 
Us Doppler in evaluarea refluxului venos
Us Doppler in evaluarea refluxului venosUs Doppler in evaluarea refluxului venos
Us Doppler in evaluarea refluxului venos
ALEXANDRU ANDRITOIU
 
Cazuri clinice-drenaje
Cazuri clinice-drenajeCazuri clinice-drenaje
Cazuri clinice-drenaje
ALEXANDRU ANDRITOIU
 
Drenajul peritoneal continuu ghidat ecografic
Drenajul peritoneal continuu ghidat ecograficDrenajul peritoneal continuu ghidat ecografic
Drenajul peritoneal continuu ghidat ecografic
ALEXANDRU ANDRITOIU
 
Tromboza venoasa profunda-o provocare terapeutica
Tromboza venoasa profunda-o provocare terapeuticaTromboza venoasa profunda-o provocare terapeutica
Tromboza venoasa profunda-o provocare terapeutica
ALEXANDRU ANDRITOIU
 
Colangiografie percutana transhepatica si drenaj biliar extern
Colangiografie percutana transhepatica si drenaj biliar extern Colangiografie percutana transhepatica si drenaj biliar extern
Colangiografie percutana transhepatica si drenaj biliar extern
ALEXANDRU ANDRITOIU
 
MORPHOLOGIC AND FUNCTIONAL MODIFICATIONS OF COMMON CAROTID ARTERIES IN HYPERT...
MORPHOLOGIC AND FUNCTIONAL MODIFICATIONS OF COMMON CAROTID ARTERIES IN HYPERT...MORPHOLOGIC AND FUNCTIONAL MODIFICATIONS OF COMMON CAROTID ARTERIES IN HYPERT...
MORPHOLOGIC AND FUNCTIONAL MODIFICATIONS OF COMMON CAROTID ARTERIES IN HYPERT...
ALEXANDRU ANDRITOIU
 
Ecografia biliara
Ecografia biliaraEcografia biliara
Ecografia biliara
ALEXANDRU ANDRITOIU
 
ULTRASOUND IN DEEP VENOUS THROMBOSIS
ULTRASOUND IN DEEP VENOUS THROMBOSISULTRASOUND IN DEEP VENOUS THROMBOSIS
ULTRASOUND IN DEEP VENOUS THROMBOSIS
ALEXANDRU ANDRITOIU
 
All About Framingham Heart Study
All About Framingham Heart StudyAll About Framingham Heart Study
All About Framingham Heart Study
ALEXANDRU ANDRITOIU
 

More from ALEXANDRU ANDRITOIU (20)

Occult cancer screening in thromboembolic disease
Occult cancer screening in thromboembolic diseaseOccult cancer screening in thromboembolic disease
Occult cancer screening in thromboembolic disease
 
Carotid atherosclerosis in patients with PAD
Carotid atherosclerosis in patients with PADCarotid atherosclerosis in patients with PAD
Carotid atherosclerosis in patients with PAD
 
PULSATILE VENOUS FLOW IN LEGS
PULSATILE VENOUS FLOW IN LEGSPULSATILE VENOUS FLOW IN LEGS
PULSATILE VENOUS FLOW IN LEGS
 
PPG and CDUS in venous reflux disease
PPG and CDUS in venous reflux diseasePPG and CDUS in venous reflux disease
PPG and CDUS in venous reflux disease
 
Abces de iliopsoas
Abces de iliopsoasAbces de iliopsoas
Abces de iliopsoas
 
Occlusion and near occlusion of carotid arteries
Occlusion and near occlusion of carotid arteriesOcclusion and near occlusion of carotid arteries
Occlusion and near occlusion of carotid arteries
 
Elastografia in tvp
Elastografia in tvpElastografia in tvp
Elastografia in tvp
 
Rolul us in ablatia v
Rolul us in ablatia vRolul us in ablatia v
Rolul us in ablatia v
 
Abordarea holistica in patologia venoasa
Abordarea holistica in patologia venoasaAbordarea holistica in patologia venoasa
Abordarea holistica in patologia venoasa
 
Aderenta si riscul cardiovascul
Aderenta si riscul cardiovasculAderenta si riscul cardiovascul
Aderenta si riscul cardiovascul
 
Indicele de rezistenta carotidian
Indicele de rezistenta carotidianIndicele de rezistenta carotidian
Indicele de rezistenta carotidian
 
Us Doppler in evaluarea refluxului venos
Us Doppler in evaluarea refluxului venosUs Doppler in evaluarea refluxului venos
Us Doppler in evaluarea refluxului venos
 
Cazuri clinice-drenaje
Cazuri clinice-drenajeCazuri clinice-drenaje
Cazuri clinice-drenaje
 
Drenajul peritoneal continuu ghidat ecografic
Drenajul peritoneal continuu ghidat ecograficDrenajul peritoneal continuu ghidat ecografic
Drenajul peritoneal continuu ghidat ecografic
 
Tromboza venoasa profunda-o provocare terapeutica
Tromboza venoasa profunda-o provocare terapeuticaTromboza venoasa profunda-o provocare terapeutica
Tromboza venoasa profunda-o provocare terapeutica
 
Colangiografie percutana transhepatica si drenaj biliar extern
Colangiografie percutana transhepatica si drenaj biliar extern Colangiografie percutana transhepatica si drenaj biliar extern
Colangiografie percutana transhepatica si drenaj biliar extern
 
MORPHOLOGIC AND FUNCTIONAL MODIFICATIONS OF COMMON CAROTID ARTERIES IN HYPERT...
MORPHOLOGIC AND FUNCTIONAL MODIFICATIONS OF COMMON CAROTID ARTERIES IN HYPERT...MORPHOLOGIC AND FUNCTIONAL MODIFICATIONS OF COMMON CAROTID ARTERIES IN HYPERT...
MORPHOLOGIC AND FUNCTIONAL MODIFICATIONS OF COMMON CAROTID ARTERIES IN HYPERT...
 
Ecografia biliara
Ecografia biliaraEcografia biliara
Ecografia biliara
 
ULTRASOUND IN DEEP VENOUS THROMBOSIS
ULTRASOUND IN DEEP VENOUS THROMBOSISULTRASOUND IN DEEP VENOUS THROMBOSIS
ULTRASOUND IN DEEP VENOUS THROMBOSIS
 
All About Framingham Heart Study
All About Framingham Heart StudyAll About Framingham Heart Study
All About Framingham Heart Study
 

Recently uploaded

Applications of NMR in Protein Structure Prediction.pptx
Applications of NMR in Protein Structure Prediction.pptxApplications of NMR in Protein Structure Prediction.pptx
Applications of NMR in Protein Structure Prediction.pptx
Anagha R Anil
 
2nd-generation Antihistaminic Part I.pptx
2nd-generation Antihistaminic Part I.pptx2nd-generation Antihistaminic Part I.pptx
2nd-generation Antihistaminic Part I.pptx
Madhumita Dixit
 
Congenital anomalies/Neural tube defects/ birth defects
Congenital anomalies/Neural tube defects/ birth defectsCongenital anomalies/Neural tube defects/ birth defects
Congenital anomalies/Neural tube defects/ birth defects
Santhoshkumari Mohan
 
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
shruti jagirdar
 
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) Cosmetics
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsStoryboard on Acne-Innovative Learning-M. pharm. (2nd sem.) Cosmetics
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) Cosmetics
MuskanShingari
 
Emergency Codes in a hospital (1) - NABH.pptx
Emergency Codes in a hospital (1) - NABH.pptxEmergency Codes in a hospital (1) - NABH.pptx
Emergency Codes in a hospital (1) - NABH.pptx
nhg782hrtq
 
All about shoulder Joint ..
All about shoulder Joint .. All about shoulder Joint ..
All about shoulder Joint ..
Aya Reyad
 
Mechanical injuries(ICS) due to sharp force.ppt
Mechanical injuries(ICS) due to sharp force.pptMechanical injuries(ICS) due to sharp force.ppt
Mechanical injuries(ICS) due to sharp force.ppt
SatrajitRoy5
 
One piece compressive Dental implant : data from Google Scholar
One piece  compressive  Dental implant : data from Google Scholar One piece  compressive  Dental implant : data from Google Scholar
One piece compressive Dental implant : data from Google Scholar
rafadjoko11
 
RESPIRATORY DISEASES by bhavya kelavadiya
RESPIRATORY DISEASES by bhavya kelavadiyaRESPIRATORY DISEASES by bhavya kelavadiya
RESPIRATORY DISEASES by bhavya kelavadiya
Bhavyakelawadiya
 
Pharmacology of Drugs for Congestive Heart Failure
Pharmacology of Drugs for Congestive Heart FailurePharmacology of Drugs for Congestive Heart Failure
Pharmacology of Drugs for Congestive Heart Failure
Dr. Nikhilkumar Sakle
 
Public Health Lecture 4 Social Sciences and Public Health
Public Health Lecture 4 Social Sciences and Public HealthPublic Health Lecture 4 Social Sciences and Public Health
Public Health Lecture 4 Social Sciences and Public Health
phuakl
 
PGx Analysis in VarSeq: A User’s Perspective
PGx Analysis in VarSeq: A User’s PerspectivePGx Analysis in VarSeq: A User’s Perspective
PGx Analysis in VarSeq: A User’s Perspective
Golden Helix
 
Nano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory projectNano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory project
SIVAVINAYAKPK
 
Call Girls Electronic City 🥰 Bangalore Call Girl No Advance Book Now
Call Girls Electronic City 🥰 Bangalore Call Girl No Advance Book NowCall Girls Electronic City 🥰 Bangalore Call Girl No Advance Book Now
Call Girls Electronic City 🥰 Bangalore Call Girl No Advance Book Now
saftyhealth48
 
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
Jim Jacob Roy
 
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)
GeorgeKieling1
 
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)
MuskanShingari
 
Call Girls Goa (india) +91-7426014248 Goa Call Girls
Call Girls Goa (india) +91-7426014248 Goa Call GirlsCall Girls Goa (india) +91-7426014248 Goa Call Girls
Call Girls Goa (india) +91-7426014248 Goa Call Girls
sagarvarma453
 
Breast cancer :hormonal discordance.pptx
Breast cancer :hormonal discordance.pptxBreast cancer :hormonal discordance.pptx
Breast cancer :hormonal discordance.pptx
Dr. Sumit KUMAR
 

Recently uploaded (20)

Applications of NMR in Protein Structure Prediction.pptx
Applications of NMR in Protein Structure Prediction.pptxApplications of NMR in Protein Structure Prediction.pptx
Applications of NMR in Protein Structure Prediction.pptx
 
2nd-generation Antihistaminic Part I.pptx
2nd-generation Antihistaminic Part I.pptx2nd-generation Antihistaminic Part I.pptx
2nd-generation Antihistaminic Part I.pptx
 
Congenital anomalies/Neural tube defects/ birth defects
Congenital anomalies/Neural tube defects/ birth defectsCongenital anomalies/Neural tube defects/ birth defects
Congenital anomalies/Neural tube defects/ birth defects
 
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
 
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) Cosmetics
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsStoryboard on Acne-Innovative Learning-M. pharm. (2nd sem.) Cosmetics
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) Cosmetics
 
Emergency Codes in a hospital (1) - NABH.pptx
Emergency Codes in a hospital (1) - NABH.pptxEmergency Codes in a hospital (1) - NABH.pptx
Emergency Codes in a hospital (1) - NABH.pptx
 
All about shoulder Joint ..
All about shoulder Joint .. All about shoulder Joint ..
All about shoulder Joint ..
 
Mechanical injuries(ICS) due to sharp force.ppt
Mechanical injuries(ICS) due to sharp force.pptMechanical injuries(ICS) due to sharp force.ppt
Mechanical injuries(ICS) due to sharp force.ppt
 
One piece compressive Dental implant : data from Google Scholar
One piece  compressive  Dental implant : data from Google Scholar One piece  compressive  Dental implant : data from Google Scholar
One piece compressive Dental implant : data from Google Scholar
 
RESPIRATORY DISEASES by bhavya kelavadiya
RESPIRATORY DISEASES by bhavya kelavadiyaRESPIRATORY DISEASES by bhavya kelavadiya
RESPIRATORY DISEASES by bhavya kelavadiya
 
Pharmacology of Drugs for Congestive Heart Failure
Pharmacology of Drugs for Congestive Heart FailurePharmacology of Drugs for Congestive Heart Failure
Pharmacology of Drugs for Congestive Heart Failure
 
Public Health Lecture 4 Social Sciences and Public Health
Public Health Lecture 4 Social Sciences and Public HealthPublic Health Lecture 4 Social Sciences and Public Health
Public Health Lecture 4 Social Sciences and Public Health
 
PGx Analysis in VarSeq: A User’s Perspective
PGx Analysis in VarSeq: A User’s PerspectivePGx Analysis in VarSeq: A User’s Perspective
PGx Analysis in VarSeq: A User’s Perspective
 
Nano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory projectNano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory project
 
Call Girls Electronic City 🥰 Bangalore Call Girl No Advance Book Now
Call Girls Electronic City 🥰 Bangalore Call Girl No Advance Book NowCall Girls Electronic City 🥰 Bangalore Call Girl No Advance Book Now
Call Girls Electronic City 🥰 Bangalore Call Girl No Advance Book Now
 
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
 
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)
 
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)
 
Call Girls Goa (india) +91-7426014248 Goa Call Girls
Call Girls Goa (india) +91-7426014248 Goa Call GirlsCall Girls Goa (india) +91-7426014248 Goa Call Girls
Call Girls Goa (india) +91-7426014248 Goa Call Girls
 
Breast cancer :hormonal discordance.pptx
Breast cancer :hormonal discordance.pptxBreast cancer :hormonal discordance.pptx
Breast cancer :hormonal discordance.pptx
 

The predictive biomarkers in pts development

  • 1. The predictive factorsThe predictive factors inin PTS developmentPTS development Alexandru Andritoiu Cristian Silosi Military Hospital Craiova
  • 2. IntroductionIntroduction • PTS is the most frequent complication of a DVT • it occurs in 20-50% of pts. with a DVT • PTS is associated with important morbidity • The development of PTS was the strongest predictor of quality of life within the first 2 years of the diagnosis of a DVT • PTS also markedly increases health care costs
  • 3. Risk factors for PTS • proximal DVT (ilio-femoral DVT) • ipsilateral recurrence of DVT • poor quality of anticoagulation • lack of resolution of DVT symptoms and signs • unprovochet DVT • advanced age • increased BMI Predictors of PTS are still poorly understood! The ability to predict which patients with DVT are likely to develop PTS, and severe PTS, is poor!
  • 4. Characteristics associated with PTS • Recurrent VTE (OR 2.5 95% CI 1.1–5.8 P = 0.030); • Previous VTE (OR 2.6 95% CI 1.3–5.5 P = 0.008); • Previous ipsilateral DVT (OR 4.2 95% CI 1.6–10.9 P = 0.002); • Varicosities (OR 6.7 95% CI 2.7–16.9 P = 0.000); • Venous insufficiency (without varicosities) (OR 4.5 95% CI 0.9–23.2 P = 0.05); • CRP above cut-off of 5 mg L−1 on 12Mo (OR 3.0 95% CI 1.3–7.3 P = 0.011). • This is in contrast with provoked DVT (OR 0.5 95% CI 0.2–1.0 P = 0.043), which appeared to reduce the risk of developing PTS
  • 5. The key players in PTS pathogenesis • Inflammation • Coagulation-fibrinolysis • Impaired thrombus resolution • Unapropriate anticoagulation • Chronic venous hypertension • Endothelial dysfunction
  • 7. J Thromb Haemost 2015; 13: 398–408. Inflammation after DVT appears to play a role in PTS development, and ICAM-1 could prove to be a predictor of PTS
  • 8. Inflammation in deep vein thrombosis and the development of post-thrombotic syndrome: A prospective study 110 pts TVP (evaluati la 12 luni pr SPT) IL-6 CRP • Rezultatele acestui studiu sugereaza ca inflamatia ar putea juca un rol in clearance-ul incomplet al trombusului, persistenta obstructiei venoase si aparitia dupa 1 an a SPT. Klappe E et al. J of Thrombosis and Haemostasis 2009;7(4):582-587
  • 9. Objectives: To investigate whether increased levels of factor (F)VIII, C-reactive protein (CRP) or D-dimer, over time, are associated with the development of PTS in patients after an acute DVT. Conclusions: Besides previous ipsilateral DVT and varicosities, CRP > 5 mgL at 12 months was strongly and independently associated with PTS. Persistent inflammation rather than hypercoagulability might be the most important etiological factor in PTS
  • 10. Levels of C-reactive protein (CRP) by PTS status Bouman AC et al. JHT 2012
  • 11. Inflammatory biomarkers and PTS • CRP • IL-6 • IL-8 • IL-10 • ICAM-1 • VCAM-1 • MMP-9 • P-selectin • TNF-alfa • ESR • ICAM-1 was significantly associated with PTS • Other biomarkers did not demonstrate a significant association with PTS. Rabinovich A, Cohen JM, Kahn SR. Thromb Res 2015
  • 12. Biomarkers could be a valuable tool for PTS risk assessment
  • 14. Markers of fibrinolysis and endothelial dysfunction in PTS • D-dimers • Fibrinogen • von Willebrand F • PAI-1 • F XIII activity • Hemophylia A significant association with PTS was found for D-dimer in studies Rabinovich A, Cohen JM, Kahn SR. JTH 2014
  • 15. D-dimer level significantly predicted PTS (P = 0.03) Measurement of D-dimer 4 months after DVT may help predict which patients are at higher risk of developing PTS and who thus may be more likely to benefit from preventive strategies such as compression stockings for PTS. Venous valvular reflux was found to be strongly associated with moderate-to-severe PTS.
  • 16. Levels of D-dimer by PTS status Bouman AC et al. JHT 2012
  • 17. Results: During a 1-year follow-up PTS developed in 48 (24%) patients, who were characterized by lower Ks, prolonged fibrin clot lysis time (CLT) and slower release of D-dimer from clots (D–Drate), together with higher plasma D-dimer, C-reactive protein and thrombin-activatable fibrinolysis inhibitor (TAFI) Our study provides evidence that denser fibrin clot formation and impaired lysis may allow the identification of patients who are likely to develop PTS following DVT.
  • 19. Conclusion: Subtherapeutic warfarin anticoagulation after a first unprovoked DVT was significantly associated with the development of PTS.
  • 21. Residual thrombosis • a lack of recanalization within the first six months after the thrombotic episode appears to be an important predictor of PTS. • incompetence of the popliteal valve increases the risk of the PTS when combined with residual vein thrombosis. Roumen-Klappe et al. J Thromb Haemost 2005
  • 22. PTS (ex)PTS (ex) Colectia Dr. A. Andritoiu
  • 23. Case-ReportCase-Report TVP ilio-femuralaTVP ilio-femurala S. Mirel, 42 aniS. Mirel, 42 ani • TVP idiopatica stg. • Ileo-Fem-Pop • CT • VSH 71 mm/h • CRP 7.7 mg/dL • Fibrinogen 622 mg/dL • Leuc 10.200/mmc • Fara semne de inflamatie locala
  • 24. Case-Report 2Case-Report 2 TVP v. popliteeTVP v. poplitee N. Simona, 32 ani • TVP acuta (idiopatica)-10 z • V poplitee stg. • CDUS • VSH 30 mm/h • Fibrinogen 202 mg/dL • CRP 1.1 mg/dL • Leuc 8.300/mmc
  • 25. In care caz riscul aparitiei SPTIn care caz riscul aparitiei SPT este mai mare?este mai mare? Raspuns corect: Cazul 1Raspuns corect: Cazul 1 Argumente: • Localizare proximala • Volum mare al trombusului • TV idiopatica • Raspuns slab la AVK (trombus masiv la INR 4.4) • Probe inflamatorii (+++)
  • 27. Association between Thrombophilia and the PTS • the various thrombophilias are important risk factors for VTE, and PTS is a frequent complication of VTE, especially after recurrent DVT. • directly by prolonging residual venous thrombosis • indirectly by increasing venous thrombotic recurrence rate. • Our meta-analysis did not demonstrate a significant association between any of the thrombophilias and PTS Rabinovich A, Kahn SR. Intern J Vasc Med 2013
  • 28. The thrombus burdenThe thrombus burden
  • 29. The Thrombus burden • Proximal DVT is associated with a higher frequency and more severe PTS than distal DVT • PTS syndrome occurs more frequently when venous thrombosis is extensive or affects proximal veins, popliteal, and calf veins. • Superficial veins involvement is also commonly associated with the development of PTS. Kreidy R- Vascular Medicine 2011
  • 31.
  • 32.
  • 33. 1821-1902 The elements comprising Virchow's triad were neither proposed by Virchow, nor did he ever suggest a triad to describe the pathogenesis of venous thrombosis