Long-term incidence of post-thrombotic syndrome in carriers of inherited thrombophilia treated with direct oral anticoagulants versus vitamin K antagonists.

Authors

Anna Poretto, Luca Spiezia, Angela Napolitano, Chiara Simion, Adalberto Codognola, Giovanni Santamaria, Elena Campello, Giampiero Avruscio, Paolo Simioni

Published in

Journal of thrombosis and thrombolysis. Oct 25, 2025. Epub Oct 25, 2025.

Abstract

Post-thrombotic syndrome (PTS) is the most frequent and disabling complication of deep vein thrombosis (DVT). Several studies have evaluated whether direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) may reduce the PTS risk over time. Data on patients with inherited thrombophilias (IT) remains scarce. To assess the long-term incidence and severity of PTS in a population of IT patients with proximal DVT of the lower extremity treated with DOACs vs. VKAs. Cases were consecutive IT patients prospectively diagnosed with a first DVT episode at Padova University Hospital, Italy between January 2014 and December 2021, and treated with DOACs. Controls were consecutive IT patients diagnosed with DVT between January 2004 and December 2019, and treated with VKAs. In both groups, the onset and grade of PTS - diagnosed using the Villalta score - was evaluated at 3, 6, 12, 24 and 36 months after DVT diagnosis. We diagnosed PTS in 71 (23.0%) DOACs and 121 (24.3%) VKAs. Crude and adjusted hazard ratios (95% Confidence Interval, CI) for the 3-year cumulative incidence of PTS in cases vs. controls were 0.93 (95% CI, 0.70-1.24) and 0.87 (95% CI, 0.61-1.23), respectively. Severe PTS was observed in 12 (16.9%) cases and 24 (10.8%) controls (p 0.62). The long-term incidence and severity of PTS was comparable between IT patients treated with DOACs or VKAs following a first DVT episode of the lower extremity. Larger more powerful studies are needed to ascertain how to mitigate the risk of developing PTS over time in this subset of patients.

PMID:
41139136
Bibliographic data and abstract were imported from PubMed on 26 Oct 2025.

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