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Biomarkers in Relation to Patency, Popliteal Reflux, and Post-thrombotic Syndrome: A Subanalysis of the

Ruben Hupperetz1,2, Aaron Iding1,2,3, Jorinde H H van Laanen4

  • 1Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center (MUMC + ), Maastricht, The Netherlands.

Thrombosis and Haemostasis
|January 27, 2026
PubMed

Insights

Biomarkers predict outcomes after deep vein thrombosis treatment. Elevated inflammatory markers correlate with poor patency, while specific markers link to reflux and post-thrombotic syndrome, suggesting biomarker-guided therapy may improve results.

Area of Science:

  • Vascular Medicine
  • Biomarkers
  • Deep Vein Thrombosis

Background:

  • Catheter-directed thrombolysis (CDT) shows variable success in preventing post-thrombotic syndrome (PTS) despite restored patency.
  • Biomarkers may elucidate PTS pathophysiology and aid patient selection for CDT.

Purpose of the Study:

  • To examine the associations between baseline biomarkers, vascular patency, popliteal reflux, and the development of PTS.
  • To explore potential differences in these associations between standard treatment (ST) and ultrasound-accelerated CDT (UA-CDT).

Main Methods:

  • Subanalysis of the CAVA trial involving 108 patients with acute iliofemoral deep vein thrombosis (DVT).
  • Randomization to ST or UA-CDT, with baseline blood analysis for 13 biomarkers.
  • Assessment of vascular patency, popliteal reflux, and PTS (Villalta score) at 1-year and long-term follow-up.

Main Results:

  • Absence of 1-year patency linked to higher baseline CRP and fibrinogen (both groups), and IL-6/VEGF-A (ST group).
  • Long-term reflux associated with lower IL-6/adiponectin (UA-CDT group).
  • Moderate-to-severe PTS linked to higher MMP-2/lower IL-10 (UA-CDT) or lower VCAM-1/adiponectin (ST).

Conclusions:

  • Pro-inflammatory processes are associated with reduced vascular patency post-DVT.
  • UA-CDT may enhance patency in patients with heightened inflammatory responses.
  • Post-thrombotic syndrome involves impaired anti-inflammatory responses and tissue remodeling, suggesting biomarker-guided selection could optimize treatment outcomes.

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