Abstract
The post-thrombotic syndrome (PTS) is a frequent, sometimes disabling complication of deep vein thrombosis (DVT) that reduces quality of life and is costly. This article discusses risk factors for PTS after DVT and available means to prevent and treat PTS, with a focus on new information in the field. After DVT, PTS will develop in 20% to 50% of patients, and severe PTS, including venous ulcers, will develop in 5% to 10%. The principal risk factors for PTS are anatomically extensive DVT, recurrent ipsilateral DVT, persistent leg symptoms 1 month after acute DVT, obesity, and older age. By preventing the initial DVT and ipsilateral DVT recurrence, primary and secondary prophylaxes of DVT will prevent cases of PTS. Based on recent evidence from a large multicenter trial, routine use of elastic compression stockings (ECS) after DVT to prevent PTS is not advocated, but in patients with DVT-related leg swelling that is bothersome, a trial of ECS is reasonable. Selecting DVT patients for catheter-directed thrombolytic treatment as a means of preventing PTS should be done on a case-by-case basis, with a focus on patients with extensive thrombosis, recent symptoms onset, and low bleeding risk. For patients with established PTS, daily use of ECS may help to relieve symptoms and edema. Intermittent compression devices can be tried in patients with moderate-to-severe PTS whose symptoms are inadequately controlled with ECS alone. A supervised exercise training program may improve PTS symptoms. Management of post-thrombotic ulcers should ideally involve a multidisciplinary approach. Important areas for future research are summarized.
Highlights
The post-thrombotic syndrome (PTS), an important chronic consequence of deep venous thrombosis (DVT), is a burdensome and potentially debilitating condition for which patients frequently seek medical advice
PTS develops in 20% to 50% of patients with DVT, even when appropriate anticoagulant therapy is used to treat the DVT
The present review focuses on risk factors for PTS after DVT and the available means to prevent and treat PTS, highlighting new information and concepts in the field
Summary
The post-thrombotic syndrome (PTS), an important chronic consequence of deep venous thrombosis (DVT), is a burdensome and potentially debilitating condition for which patients frequently seek medical advice. Typical signs may include leg edema, redness, dusky cyanosis when the leg is in a dependent position, perimalleolar or more extensive telangiectasiae, new varicose veins, stasis hyperpigmentation, thickening of the skin and subcutaneous tissues of the lower limb known as lipodermatosclerosis, and in severe cases, leg ulcers, which may be precipitated by minor trauma These are characteristically chronic, painful, and slow to heal; require close medical attention; and often recur. The intensity of symptoms and signs of PTS tends to increase over the course of the day Their severity ranges from minimal discomfort and cosmetic concerns to severe clinical manifestations such as chronic pain, intractable edema, and leg ulceration.
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