Prevention and treatment of the post‐thrombotic syndrome

Abstract

Essentials Post thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) with limited treatment options.Uniformity of the diagnostic strategy and the use of risk prediction models might improve treatment outcomes.Extending knowledge on the pathophysiology and improving therapeutic options is paramount for progress. PTS management should evolve to a multimodal approach with treatment tailored to individual patients' needs. Post thrombotic syndrome (PTS) is a common chronic complication of deep vein thrombosis of the leg (DVT). Treatment options are limited therefore emphasis is placed on its prevention. Several risk factors have been recognized, but were so far not used for risk stratification or translation into prediction models. Early interventions did not yet result in more successful preventive treatment strategies; for the acute phase of DVT there is equipoise on the value of elastic compression, as well as on catheter directed thrombolysis. There are no drugs specifically targeted at PTS prevention. The use of anticoagulant medication such as direct oral anticoagulants (DOACs) might decrease PTS incidence, but this needs to be corroborated. Both research into more effective treatment options as well as future PTS management may benefit from a uniform diagnostic strategy and the use of prediction rules to better allocate treatment and thereby increase treatment efficacy.

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

“…17 Attention to PTS prevention in such patients includes optimal anticoagulant treatment and lifestyle measures. [17][18][19] In patients who develop PTS, assessing the contralateral leg may provide, in the absence of previous DVT, a reliable estimate of the presence or absence of preexisting PVI. This may help to predict the likelihood of success if additional PTS treatments such as endovascular recanalization procedures are considered.…”

Fibroid Expulsion after Uterine Artery Embolization

“…5 A retrievable suprarenal IVC filter was placed prior to her gynecologic surgery, but she was otherwise maintained on anticoagulation throughout her clinical course, as prompt and adequate anticoagulation is thought to help prevent PTS. 6 The patient's extensive left lower extremity DVT was provoked in the setting of a massively enlarged, leiomyomatous uterus exerting further mass effect upon the already narrowed left common iliac vein from her May-Thurner lesion. While her DVT was considered chronic by the time her pelvic vein reconstruction was performed, a good technical result was obtained in a single session with mechanical thrombectomy and endovascular stenting to relieve the outflow obstruction.…”

Venous thromboembolism research priorities: A scientific statement from the American Heart Association and the International Society on Thrombosis and Haemostasis

“…However, only D-dimer has been adequately studied for guiding management decisions, and little is known on Up to 50% of patients develop long-term exercise limitation after PE or the PTS following DVT. 37,38 Yet the effect of DVTs and PEs on long-term health status and societal impacts for many of those afflicted is not well established. More population-based studies are needed to examine patient-centered outcomes, including long-term symptoms, functional status, and consequent effects on quality of life.…”