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Post-thrombotic syndrome after upper extremity deep vein thrombosis: An international Delphi consensus study
Robert J C M F de Kleijn1, Ludo Schropp1, Eline S van Hattum1
1Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Journal of Thrombosis and Haemostasis : JTH
|May 24, 2022
Summary
A new clinical score combining symptoms, signs, and functional disability was developed to diagnose upper extremity post-thrombotic syndrome (UE-PTS) following deep vein thrombosis (DVT). This score aims to standardize UE-PTS diagnosis and improve research on DVT treatments.
Area of Science:
- Vascular Medicine
- Clinical Epidemiology
- Patient-Reported Outcomes
Background:
- Primary deep vein thrombosis of the upper extremity (UEDVT) is uncommon, yet leads to post-thrombotic syndrome in up to 60% of patients, significantly impacting quality of life.
- The absence of a standardized diagnostic and classification method for upper extremity post-thrombotic syndrome (UE-PTS) hinders research into effective UEDVT treatments.
Purpose of the Study:
- To establish a consensus-based clinical score for diagnosing upper extremity post-thrombotic syndrome (UE-PTS).
- To define the essential components of a clinical scoring system for UE-PTS.
Main Methods:
- An international Delphi consensus study involving 25 experts was conducted over four rounds.
- An initial online focus group survey with 20 patients treated for UEDVT informed the Delphi study parameters.
- Consensus was defined as 70% agreement, utilizing Likert scales and open/multiple-choice questions.
Main Results:
- Agreement was achieved on a composite score incorporating five symptoms and three clinical signs of UE-PTS.
- Each sign and symptom is scored on a 0-3 severity scale, resulting in an ordinal classification (none/mild/moderate/severe PTS).
- A functional disability score measuring the impact on arm function was also included.
Conclusions:
- A consensus-based composite score for diagnosing UE-PTS, combining signs, symptoms, and functional disability, has been developed.
- Clinical validation of this new UE-PTS score in a large patient cohort is essential for its future application in research.
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