Distinct Predictors of Post-thrombotic Symptoms, Signs, and Ulcers after a First Episode Deep Vein Thrombosis: A RIETE Registry Study

OBJECTIVE: Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT), yet predictors of its individual manifestations remain poorly characterised.

METHODS: In a multicentre prospective cohort of 3 610 adults with a first symptomatic lower limb DVT enrolled in the RIETE registry, PTS manifestations were assessed at 12, 24, and 36 months. Villalta components were dichotomised to enhance reproducibility across centres. Multivariable logistic regression was used to identify independent baseline predictors and early post-diagnosis exposures associated with PTS symptoms, signs, and venous ulceration.

RESULTS: At 12 months, 34.7% of patients reported symptoms, 43.2% had signs, and 1.1% developed venous ulcers (increasing to 4.5% at 36 months). Female sex (adjusted odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.07 - 1.44) and younger age (aOR 0.75, 95% CI 0.60 - 0.93 for ≥ 80 years vs. < 80 years) predicted symptoms but not signs or ulcers. Older age was associated with signs and ulcers. Higher body weight and proximal DVT predicted symptoms and signs, while ulcer risk increased in a dose dependent manner with body weight, particularly in men (aOR 4.12, 95% CI 1.18 - 14.3). Elastic stocking use was associated with symptom reporting at 12 months. Thrombolysis and shorter anticoagulation duration were associated with fewer PTS related signs. Associations remained generally consistent over time.

CONCLUSION: Predictors differ across PTS domains, suggesting distinct pathophysiologic pathways and highlighting the need for risk stratified follow up and targeted prevention strategies after DVT.