dvt_pts
Table of Contents
DVT and post-thrombotic syndrome (PTS)
see also:
introduction
- 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
- 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)
prevention of PTS in patients who have DVT
- 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
dvt_pts.txt · Last modified: 2013/08/06 08:06 by 127.0.0.1