Prevention and Management of the Post-Thrombotic Syndrome

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.

Accuracy of contralateral Villalta score to assess for pre‐existing chronic venous insufficiency in patients with unilateral deep vein thrombosis

“…The VS was developed for the purpose of diagnosing PTS, has proven inter-observer reliability, and is responsive to clinical change, but may be somewhat nonspecific. [9][10][11] Indeed, studies have reported that up to 40% of patients with PTS also have a high (>4) VS in the leg contralateral to DVT (cl-VS), which could reflect the presence of other conditions, most commonly primary venous insufficiency (PVI), rather than true PTS. [12][13][14] However, in those studies, cl-VS was assessed only once, either during the acute phase of DVT or during the follow-up phase after DVT, or in patients with a history of previous DVT.…”

Feasibility of anticoagulation using low molecular-weight heparin during catheter-directed thrombolysis for lower extremity deep venous thrombosis

“…Although anticoagulation therapy has proven to be effective and safe in preventing PE and recurrence of DVT and improving patients’ quality of life [ 3 , 4 ], DVT management is still facing challenging since anticoagulation alone does not resolve the thrombus formed in the vein. Consequently, approximately 25 ~ 50% of proximal DVT patients develop post-thrombotic syndrome (PTS) because of valve incompetence and long-term venous hypertension [ 5 ].…”

Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis

“…Consequently, approximately 25~50% of proximal DVT patients develop post-thrombotic syndrome (PTS) because of valve incompetence and long-term venous hypertension. 5 Catheter-directed thrombolysis (CDT) has been proposed for symptomatic patients with severe DVT, particularly in the setting of phlegmasia alba dolens. 6 Numerous studies reported the clinical bene t of CDT in the treatment of symptomatic DVT.…”