DVT and post-thrombotic syndrome (PTS)

see also:

• Rx of venous thrombosis (DVT/PE) and superficial thrombophlebitis - American College of Chest Physicians guidelines 2012
• deep venous thrombosis (DVT)
• venous insufficiency of the leg

• PTS is a cluster of leg symptoms and signs attributable to previous DVT.
• PTS occurs in about one-third of patients after acute DVT and up to two-thirds who have had an iliofemoral DVT
• most prominent symptoms are chronic dependent swelling and pain, discomfort on walking, and skin discoloration.
• severity of symptoms may vary over time
• it causes venous insufficiency of the leg and the most severe manifestation is venous leg ulcers

• risk factors for higher severity PTS Villalta score at 24 months:¹⁾
  • mild PTS severity at 1 month (2x risk)
  • moderate PTS severity at 1 month (5x risk)
  • high PTS severity at 1 month (7x risk)
  • thrombosis of common femoral or iliac vein (2.2 higher score compared with distal DVT)
  • higher body mass index (0.14 increase in score per kg/m²)
  • PH ipsilateral venous thrombosis (1.78 increase in score)
  • older age (0.30 increase in score per 10-year age increase)
  • female sex (0.79 increase in score)

• compression stockings
  • compression stockings started within 2 weeks of DVT and continued for 2 years reduce PTS by about 50% and do not alter the frequency of recurrent VTE.
  • patients with proximal DVT and a previous DVT in the same leg and who have marked symptoms are expected to gain the most benefit from compression stockings.
• avoid permanent ivc filter if not needed
  • if anticoagulation is not C/I then ivc filter probably should not be used
• minimise risk of recurrent DVT
  • anticoagulation as per guidelines
• consider early clot removal in certain patients with extensive ileofemoral DVT
  • see guidelines - evidence is inconclusive but certain patients may benefit from early clot removal by thrombolysis
• hydroxyrutoside flavonoid drugs probably do more harm than good
  • venoactive medications (eg, rutosides, defibrotide, and hidrosmin) probably should NOT be used