Post thrombotic Syndrome Godwin Tse LA-TRAP Winter 2011 What is post-thrombotic syndrome? • Long-term complication of deep venous thrombosis (DVT) that is characterized by chronic, persistent pain, swelling and other signs in the affected limb • Caused by damage to veins and valves Signs and Symptoms Signs • Edema • Eczema • Hyperpigmentation • Redness • Secondary varicose veins • Lipodermatoschlerosis (LDS) • Venous Ulcers Symptoms • Heaviness • Pain • Swelling • Itching • Cramps • Aching • Symptoms worsen with activity and standing DVT Post thombotic syndrome Risk factors • • • • • • Age >65 Sex Location of DVT Recurrent DVT Lack of long-term anticoagulation Obesity Prevention • DVT Prophylaxis • Optimal duration of anticoagulation After initial DVT: • Prevention of recurrent DVT • Compression stockings Treatment • • • • Compression stockings/pump Elevation of extremity while resting Lifestyle changes Medications PTS vs recurrent DVT Over 24h span (DVT): • Dramatic onset of pain • Persistent swelling • Duplex ultrasound ▫ May difficult to distinguish due to abnormalities still present in the venous segment Social impact • Costs ▫ Increased medical costs ▫ Lost of productivity at work/home • Decreased quality of life References • http://www.stoptheclot.org/natt_publications/post_thrombotic_sy ndrome.pdf • http://www.venousdiseasecoalition.org/diseaseinfo/pts/ • http://www.ncbi.nlm.nih.gov/pubmed/12163001 • http://dermatology.cdlib.org/143/case_presentations/postthrombo tic_syndrome/vereecken.html • http://www.inate.org/en/1/2/6/23/default.aspx#Whatispostthrom boticsymdrome • http://emedicine.medscape.com/article/461449-overview • http://www.fvleiden.org/ask/82.html • http://circ.ahajournals.org/cgi/content/full/121/8/e217