Post-thrombotic syndrome
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Post-Thrombotic Syndrome (PTS) is the term used to describe signs and symptoms that may occur as long-term complications of deep vein thrombosis (DVT). It may also be referred to as post-phlebitic syndrome or venous stress disorder.
References
Pathophysiology
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References
Causes
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Causes
Despite ongoing research, the cause of PTS is not entirely clear. Inflammation is thought to play a role [1][2] as well as damage to the venous valves from the thrombus itself. This valvular incompetence combined with persistent venous obstruction from thrombus increases the pressure in veins and capillaries. Venous hypertension induces a rupture of small superficial veins, subcutaneous hemorrhage[3] and an increase of tissue permeability. That is manifested by pain, swelling, discoloration, and even ulceration.[4]
References
- ↑ Shbaklo H, Holcroft CA, Kahn SR. Levels of inflammatory markers and the development of the post-thrombotic syndrome. Thromb Haemost 2009; 101:505-12.
- ↑ Roumen-Klappe EM, Janssen MC, Van Rossum J, Holewijn S, Van Bokhoven MM, Kaasjager K, et al. Inflammation in deep vein thrombosis and the development of post-thrombotic syndrome: a prospective study. J Thromb Haemost 2009;7:582-7.
- ↑ Pirard D., Bellens B., Vereecken P. The post-thrombotic syndrome – a condition to prevent. Dermatology Online Journal 14 (3): 13
- ↑ Vedantham S. Valvular dysfunction and venous obstruction in the post-thrombotic syndrome. Thromb Res 2009; 123 Suppl 4: S62-5.
Differentiating Post-thrombotic syndrome from other Diseases
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References
Epidemiology and Demographics
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Incidence
PTS can affect 23-60% of patients in the two years following DVT of the leg. Of those, 10% may go on to develop severe PTS, involving venous ulcers.[1]
References
- ↑ Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolysis 2009; 28: 465-76.
Risk Factors
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Risk Factors
Investigators have determined that the following factors increase patients’ risk of developing PTS:[1][2][3][4][5][6][7]
- age > 65
- proximal DVT
- a second DVT in same leg as first DVT (recurrent ipsilateral DVT)
- persistent DVT symptoms 1 month after DVT diagnosis
- obesity
- poor quality of anticoagulation control (i.e. dose too low) during the first 3 months of treatment
References
- ↑ Tick LW, Kramer MH, Rosendaal FR, Faber WR, Doggen CJ. Risk factors for post-thrombotic syndrome in patients with a first deep venous thrombosis. J Thromb Haemost. 2008;6:2075-81.
- ↑ Prandoni P, Lensing AWA, Cogo A, Cuppini S, Villalta S, Carta M, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996;125:1-7.
- ↑ Shbaklo H, Kahn SR. Long-term prognosis after deep venous thrombosis. Curr Opin Hematol 2008;15:494-8.
- ↑ Kahn SR, Kearon C, Julian JA, Mackinnon B, Kovacs MJ, Wells P, et al. Predictors of the post-thrombotic syndrome during long-term treatment of proximal deep vein thrombosis. J Thromb Haemost 2005;3:718-23.
- ↑ Ageno W, Piantanida E, Dentali F, Steidl L, Mera V, Squizzato A, et al. Body mass index is associated with the development of the post-thrombotic syndrome. Thromb Haemost 2003;89:305-9.
- ↑ van Dongen CJ, Prandoni P, Frulla M, Marchiori A, Prins MH, Hutten BA. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost 2005;3:939-42.
- ↑ Kahn SR, Ginsberg JS. Relationship between deep venous thrombosis and the postthrombotic syndrome. Arch Intern Med 2004;164:17-26.
Natural History, Complications and Prognosis
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References
Diagnosis
Diagnosis
Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | Ultrasound | CT | Other Imaging Findings | Other Diagnostic Studies
Treatment
Treatment
Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Case Studies
Case Studies
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