Abstract
The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency secondary to prior deep vein thrombosis (DVT). It affects up to 50% of patients after proximal DVT. There is no effective treatment of established PTS and its management lies in its prevention after DVT. Optimal anticoagulation is key for PTS prevention. Among anticoagulants, low-molecular-weight heparins have anti-inflammatory properties, and have a particularly attractive profile. Elastic compression stockings (ECS) may be helpful for treating acute DVT symptoms but their benefits for PTS prevention are debated. Catheter-directed techniques reduce acute DVT symptoms and might reduce the risk of moderate–severe PTS in the long term in patients with ilio-femoral DVT at low risk of bleeding. Statins may decrease the risk of PTS, but current evidence is lacking. Treatment of PTS is based on the use of ECS and lifestyle measures such as leg elevation, weight loss and exercise. Venoactive medications may be helpful and research is ongoing. Interventional techniques to treat PTS should be reserved for highly selected patients with chronic iliac obstruction or greater saphenous vein reflux, but have not yet been assessed by robust clinical trials.
Highlights
The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency (CVI) that occurs secondary to a prior deep vein thrombosis (DVT) [1]
The SOX trial did not show any benefit of Elastic compression stockings (ECS) for treating early symptoms, but the first follow-up occurred at 14 days
Even though PTS guidelines do not support the use of ECS for PTS prevention, they suggest the use of ECS for management of acute DVT symptoms [15]
Summary
The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency (CVI) that occurs secondary to a prior deep vein thrombosis (DVT) [1]. It develops in 20–50% of patients after a proximal DVT [2]. Like any form of CVI, PTS is attributed to ambulatory venous hypertension and this can be caused either by residual venous obstruction, valvular damage, or both. PTS is not a lethal condition but it negatively impacts quality of life, with an effect comparable to that of other chronic conditions such as heart failure or diabetes mellitus [4,5,6]. This review focuses on clinically relevant PTS management questions and addresses controversies within the field
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