Prevention and Management of the Post-Thrombotic Syndrome

Ilia Makedonov, Susan R Kahn, Jean-Philippe Galanaud, Ilia Makedonov, Susan R Kahn, Jean-Philippe Galanaud

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.

Keywords: catheter-directed thrombolysis; deep vein thrombosis; elastic compression stockings; low-molecular-weight heparins; post-thrombotic syndrome.

Conflict of interest statement

J.P.G. received consultant fees from Sanofi S.A. and Servier Laboratories; research grants from Leo Pharma, Bayer AG and Bristol-Myers Squibb-Pfizer; and a travel grant from Innothéra. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results

Figures

Figure 1
Figure 1
Signs of PTS included in the Villalta scale. Each one is scored out of 3 (with 0 being absent and 3 being most severe). Symptoms are also scored out of 3, and include pain, cramps, heaviness, paresthesia and pruritus. Scores 5–9 represent mild PTS, 10–14 is moderate and ≥ 15 is severe. The presence of a venous ulcer automatically classifies the PTS as severe. The Villalta scale score is non-specific and does not distinguish pre-existing chronic venous insufficiency from PTS.

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