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How I treat the postthrombotic syndrome.

Authors
  • Rabinovich, Anat1
  • Kahn, Susan R2, 3
  • 1 Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. , (Israel)
  • 2 Center for Clinical Epidemiology, Jewish General Hospital/Lady Davis Institute, and.
  • 3 Division of Internal Medicine, Department of Medicine, McGill University, Montreal, QC, Canada. , (Canada)
Type
Published Article
Journal
Blood
Publisher
American Society of Hematology
Publication Date
May 17, 2018
Volume
131
Issue
20
Pages
2215–2222
Identifiers
DOI: 10.1182/blood-2018-01-785956
PMID: 29545327
Source
Medline
Language
English
License
Unknown

Abstract

The postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that imposes significant morbidity, reduces quality of life, and is costly. After DVT, 20% to 50% of patients will develop PTS, and up to 5% will develop severe PTS. The principal risk factors for PTS are anatomically extensive DVT, recurrent ipsilateral DVT, obesity, and older age. By preventing the initial DVT and DVT recurrence, primary and secondary prophylaxis of DVT will reduce occurrence of PTS. The effectiveness of elastic compression stockings (ECSs) for PTS prevention is controversial. Catheter-directed thrombolysis is not effective to prevent PTS overall but may prevent more severe forms of PTS and should be reserved for select patients with extensive thrombosis, recent symptoms onset, and low bleeding risk. For patients with established PTS, the cornerstone of management is ECS, exercise, and lifestyle modifications. Surgical or endovascular interventions may be considered in refractory cases. Because of a lack of effective therapies, new approaches to preventing and treating PTS are needed. This article uses a case-based approach to discuss risk factors for PTS after DVT, how to diagnose PTS, and available means to prevent and treat PTS, with a focus on new information in the field. © 2018 by The American Society of Hematology.

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