Diagnosis of deep vein thrombosis, and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014

Figure 1 Rotterdam approach to safely exclude and diagnose deep vein thrombosis[8,9]. CUS: Compression ultrasonography; DVT: Deep vein thrombosis.

Figure 2 Recanalization of proximal deep vein thrombosis is usually delayed and may be completed after 3, 6 to 9 mo post-deep vein thrombosis with a high incidence of reflux, deep vein thrombosis recurrence and PTS. A: The relationship between the time of complete recanalization after deep vein thrombosis (DVT) (lysis time of leg vein thrombosis) appears to be 3 mo for those DVT patients who did not develop reflux, but appeared to be about 9 to 12 mo for those DVT patients who developed reflux as a main determinant for the development of PTS [Common femoral vein (CFV), superficial femoral vein (SFV), middle superficial femoral vein (SFM), distal superficial vein (SFD), popliteal vein (PPT), posterior tibial vein (PTV), greater saphena vein (GSV)][15]; B: Localization of reflux in patients with delayed recanalization (Figure 2A) of deep vein thrombosis[15].

Figure 3 Event free recurrence rate of venous thromboembolism in 78 “low risk” DVT patients with no residual vein thrombosis at 3 mo post-DVT (RVT Neg) as compared to 92 "high risk" DVT patients with RVT at 3 mo post-DVT (RVT Pos group) after discontinuation of anticoagulation during 2 years follow-up in the prospective study of Siragusa et al[18]. RVT: Residual vein thrombosis.

Figure 4 Incidence of the post-thrombotic syndrome according to the CEAP classification in patients with deep vein thrombosis during long-term follow-up[32].

Figure 5 Rotterdam approach to the post-thrombotic syndrome according to Wentel et al[33]. PTS: Postthrombotic syndrome; MECS: Medical elastic compression stockings.

Figure 6 2007 Rotterdam Erasmus study design, time schedule, clinical score assessment and procedures for prospective evaluation of post-DVT venous thromboembolism-recurrence and postthrombotic syndrome. PTS: Postthrombotic syndrome; MECS: Medical elastic compression stockings.

Figure 7 European DVT - postthrombotic syndrome Bridging the Gap study design 2014. MECS: Medical elastic compression stockings.

Figure 8 Algorith modification of the D-dimer strategy according to the modified PROLONG study 23 for the duration and extension of anticoagulant treatment in post-DVT patients on top of objective risk stratification in Figure 7.