Systematic review and meta-analysis of the pooled rate of post-thrombotic syndrome after isolated distal deep venous thrombosis

Published:October 15, 2022DOI:
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      To identify the rate of post-thrombotic syndrome (PTS) after isolated distal deep venous thrombosis (IDDVT) by performing a meta-analysis of the rate of PTS across randomised and observational studies.

      Data sources

      MEDLINE, Embase, the Cochrane Controlled Trials Register,, European Union Clinical Trials, International Standard Randomised Controlled Trial Number and the Australian and New-Zealand Trials Registries.

      Review methods

      The review followed PRISMA guidelines using a registered protocol (CRD42021282136). Databases were searched up to December 2021 and prospective studies reporting the development of post-thrombotic syndrome were included; these were pooled with meta-analysis.


      The results showed a post-thrombotic rate of 17% (95% CI 11-26%, p<.01) (7 studies, 217 cases, 1105 participants). Heterogeneity was high (I2= 89%). On meta-regression, the rate of post-thrombotic syndrome was not correlated with the length of follow up (p=.71). Three studies (302 participants) reported the severity of post-thrombotic syndrome: 78% were mild (Villalta score 5-9); 11% were moderate (Villalta score 10-14) and 11% were severe (Villalta score 15 or more).


      The risk of post-thrombotic syndrome after IDDVT is 1 in 5 and the risk of severe clinical manifestations, including ulceration, is 1 in 50. There was significant clinical, methodological and statistical heterogeneity between studies and a substantial risk of bias from pooled studies. Randomised trials to support interventions for prevention of post-thrombotic syndrome are urgently needed.


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