Prevention and treatment of the post-thrombotic syndrome

Abstract

Post thrombotic syndrome (PTS) is a common chronic complication of deep vein thrombosis of the leg (DVT). Treatment options are limited therefore emphasis is placed on its prevention. Several risk factors have been recognized, but were so far not used for risk stratification or translation into prediction models. Early interventions did not yet result in more successful preventive treatment strategies; for the acute phase of DVT there is equipoise on the value of elastic compression, as well as on catheter directed thrombolysis. There are no drugs specifically targeted at PTS prevention. The use of anticoagulant medication such as direct oral anticoagulants (DOACs) might decrease PTS incidence, but this needs to be corroborated. Both research into more effective treatment options as well as future PTS management may benefit from a uniform diagnostic strategy and the use of prediction rules to better allocate treatment and thereby increase treatment efficacy.

Keywords: deep vein thrombosis; management; post thrombotic syndrome.

Figure 1

Difference in patient numbers for the severity categories of the Villalta score in relation to scoring method used for the diagnosis, original Villalta scoring method by Prandoni (2 scores of ≥5 with at least 3 months apart) vs the ISTH consensus scoring method based on data from the IDEAL study19. The ISTH scoring method “overestimates” mild post thrombotic syndrome (PTS), while there is no difference for moderate and severe PTS

Figure 2

Schematic representation for the proposed pathophysiology of post thrombotic syndrome (PTS)

Figure 3

Proposed management strategy for post thrombotic syndrome (PTS) prevention, with multiple adjunctive preventive treatment modalities in addition to anticoagulant therapy