Postthrombotic syndrome

Given that VTE is often clinically silent and potentially fatal, prevention strategies have the greatest potential to improve patient outcomes.2 To rely on the early diagnosis and treatment of VTE is unacceptable because many patients will die before treatment can be initiated. Furthermore, even clinically silent disease is associated with long-term morbidity from the postthrombotic syndrome and predisposes the patient to future thromboembolic events. Despite an immense body of literature that overwhelmingly supports the widespread use of... 

Postthrombotic syndrome occurs in 20% to 50% of patients within 8 years after a DVT. Wearing graduated compression stockings (GCS) after a DVT reduces the risk of PTS by as much as 50%. Current guidelines recommend the use of GCS with an ankle pressure of 30 to 40 mm Hg for 2 years after a DVT. To be effective, GCS must fit properly. Traditionally, strict bed rest has been recommended after a DVT, but this approach has now been refuted and patients should be encouraged to ambulate as tolerated.8,34... 

Postthrombotic syndrome (a long-term complication of DVT caused by damage to venous valves) may produce chronic lower extremity swelling, pain, tenderness, skin discoloration, and ulceration. 

The objectives of treating VTE are to prevent the development of PE and the postthrombotic syndrome, to reduce morbidity and mortality from the acute event, and to minimize adverse effects and cost of treatment. 

Patients should be monitored for resolution of symptoms, the development of recurrent thrombosis, and symptoms of the postthrombotic syndrome, as well as for adverse effects from the treatments described in this chapter. 

Johnson Bp Manzo PA, Bergelin RO, et al. Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis a one to six year follow-up. J Vase Surg I 995 21 307-3 13. 

Thrombotic (blood clot) events, and subsequent complications, are a leading cause of morbidity and mortality in the general population.1 In 2005, it was estimated that there were more than 900,000 total venous thromboembolism events in the United States,2 two thirds of which were acquired in hospital. More than 600,000 of those were nonfatal venous thromboembolism events. Nearly 300,000 were fatal events, including more than 2,200 cases of deep venous thrombosis and 294,000 cases of pulmonary embolism. The majority deaths (93%) were due to sudden fatal pulmonary embolism, or were a consequence of undiagnosed venous thromboembolism. It was estimated that 340,000 patients developed complications from venous thromboembolism, including 336,000 with postthrombotic syndrome and 3,300 with chronic thromboembolic pulmonary hypertension. 

Unfortunately, the disease is often clinically silent and the first manifestation may be sudden death. In some case series, 80% of patients who died suddenly had some evidence of pulmonary embolism at the time of autopsy. Beyond the symptoms produced by the acute event, the long-term sequelae of VTE, such as the postthrombotic syndrome and recurrent thromboembolic events, also cause substantial pain and suffering. ... 

In addition to anticoagulant therapy for patients with proximal DVT, wearing graduated compression stockings can rednce the risk of developing the postthrombotic syndrome by as mnch as 50%. To be... 

Venous ulcers (including healed ulcers), deep vein thromhosis, superficial thrombophlebitis, varicose veins with severe edema, postthrombotic syndrome, mild lymphedema... 

Clinically, a limb edema is the result of swelling from excessive accumulation of serous fluid in tissue. It depends on two factors. First, excessive liquid is generated in the interstitial space due to obstructive venous diseases presenting as varicose veins or postthrombotic syndrome, heart or kidney failure, metabolic deficits with altered and low protein concentration in the blood, or many other conditions. Second, a lymphatic drainage deficit due to alteration of the lymphatic system can result in water and protein stagnation. Lymphedema frequently occurs in many upper- and lower-limb pathologies. 

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