Post-Thrombotic Syndrome

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Post-Thrombotic Syndrome

As if having a Deep Vein Thrombosis (DVT) is not bad enough, about one in two people with DVT will develop a complication called Post-Thrombotic Syndrome (PTS)1. Moreover, about 20-50% of people who have had a DVT develop Post-Thrombotic Syndrome 2. Post-Thrombotic Syndrome can have devastating, long-term consequences for those who suffer from it. Indeed, the quality of life for people with this condition is quite low, rivaling that of cancer and congestive heart failure3.

What is Post-Thrombotic Syndrome?

Post-Thrombotic Syndrome occurs after a blood clot has formed inside of a vein. If the clot is not dissolved or removed, it will reorganize and resorb in a process called fibrinolysis. The resulting fibrotic tissue blocks the normal flow of blood through the vessel, causing the blood to accumulate in the veins. This additional, stagnant blood wreaks havoc on the veins themselves. The veins become inflamed, the valves in the veins no longer function properly, and pressure within the veins builds to unhealthy levels4,5. This may lead to a condition called venous insufficiency, which simply means the veins no longer function as they should.

What Causes Post-Thrombotic Syndrome?

Post-Thrombotic Syndrome usually affects people who have or have had DVT but did not receive treatment. The condition occurs when a DVT goes untreated for some time. Over this time, the damage to the vein accumulates. Damaged valves, a consequence of chronic DVT, cannot repair themselves. Pressure builds and the amount of blood and fluid in the leg increases. Clotting can also cause damage to the walls of the vein. Once Post Thrombotic Syndrome occurs, simply removing the clot does not reverse that damage done by the clot. Therefore, early DVT diagnosis and effective DVT treatment is so important—to avoid Post Thrombotic Syndrome. Even if the DVT is advanced and PTS has begun, it is best to seek treatment early since damage tends to worsen with time6.

Symptoms and Complications

The first step is to look for and address symptoms that could be DVT. Symptoms of DVT include pain, swelling, warmth, and redness in the affected leg. The symptoms of Post-Thrombotic Syndrome are similar to those of DVT, but usually reflect a worsening of DVT symptoms. Symptoms include:

  • Swelling of the leg (edema)
  • Throbbing pain in the leg
  • Heaviness and tiredness of the leg
  • Cramping and itchiness
  • Discoloration of the skin
  • Skin dryness and dark skin pigmentation

Formation of varicose veins may also occur and venous ulcers may develop. In severe cases, no blood can flow through the vein due to the damage it sustained.

Causes and Risk Factors

Post-Thrombotic Syndrome is more likely to occur in certain individuals. People who are obese, older, or who have varicose veins are more likely to develop the condition7,8. On the other hand, the use of graduated compression stockings, the use of thrombolysis (clot-busting medications), and faithful use of blood-thinning medications can reduce the risk of developing Post-Thrombotic Syndrome9,10,11.

Physical, Psychological, and Social Effects

Dealing with the symptoms is frustrating, particularly for people who were physically active before their PTS. While some patients manage to recover, others suffer from long-term to permanent disability. When this happens, patients tend to lose interest in pursuing their hobbies. Long-term symptoms affect the self-esteem, family and social relationships, and overall well-being. Quality of life suffers.

Diagnosis and Challenges

The diagnosis of Post-Thrombotic Syndrome is a clinical diagnosis, which means additional testing may not be necessary6. If someone has a history of DVT and obvious symptoms and signs of venous insufficiency, the doctor can make the diagnosis without any further testing. Unfortunately, a DVT may not cause symptoms. Therefore, it is not always possible to know if a patient has had a DVT. Thus, it is possible to be diagnosed with Post-Thrombotic Syndrome even without having been previously diagnosed with DVT (though an undiagnosed DVT probably existed).

When testing is needed, duplex ultrasound is usually the test of choice. Doctors may perform different tests to determine the occurrence of PTS6. The doctor will determine if the vein is compressible. A vein that cannot be compressed with the ultrasound probe likely means a clot is present in the leg vein. The doctor will also look for signs of venous reflux, that is, backwards blood flow through the vein12.

Post-Thrombotic Syndrome Treatment

Treatment options vary depending on the severity of the condition. Standard treatment for virtually all patients with Post-Thrombotic Syndrome includes elevation of the affected limb(s), exercise, and compression therapy/compression stockings. Doctors usually prescribe blood-thinning medications to prevent the formation of blood clots in the vein. If a clot remains in the leg, several clot-removing interventions exist including catheter-directed thrombolysis, venoplasty and stenting, and mechanical clot disruption. VENITI, a world-renowned company that develops medical devices used in treating venous disorders, offers patient information resources and treatment solutions.

Patients may choose among the following Post-Thrombotic Syndrome treatment options:

Elevation and Exercise

Doctors usually advise patients to elevate the affected extremity while resting or sleeping. This helps blood return to the heart with the help of gravity. Elevation is free, easy, and surprisingly effective. Exercise is another free treatment for Post-Thrombotic Syndrome. Exercises that involve flexion of the ankle and calf-strengthening, such as walking, are particularly helpful13.

Compression Stockings

Compression stockings are a common treatment for Post-Thrombotic Syndrome. It is important to wear compression stockings that fit well and provide a sufficient amount of compression. Patients may buy custom fitted stockings from trusted manufacturers and distributors. Though research on the benefits of wearing these stockings is still ongoing, the results of some case studies prove that this practice is highly effective.

Made of special elastic fabric, compression stockings apply pressure to the ankle, improving blood flow and reducing pain and swelling. The tightness of the stockings depends on the patients’ needs and condition. These products are available in three different styles: below-knee, above-knee, and full-length. Your doctor will help you choose the most appropriate stocking type and degree of pressure.

Stenting

Stenting is a modern treatment for Post-Thrombotic Syndrome, May-Thurner Syndrome, and DVT. A physician inserts a metal mesh tube called a stent to the area of the clot. A balloon is often used to expand the stent, which also expands the narrowed vein. The stent is left in the vein to permanently hold the vein open.

VENITI has developed a system that includes a self-expanding stent, VICI VENOUS STENT®. The VICI VENOUS STENT’s high degree of crush resistance allows it to resist compression. Its uniform end-to-end shape helps maintain structural integrity and improve blood flow through the vessel. The venous stent from VENITI is strong but flexible, so patients can still perform their normal activities.

How VENITI Can Help

VENITI focuses on developing innovative devices used to treat venous disorders. We have a team of scientists and medical professionals who work hard to improve our products, which include the VICI VENOUS STENT. It is our mission to make a significant contribution to the medical community, which is why we offer high quality devices to doctors from across the globe.

At VENITI, we not only provide medical devices and treatment solutions; we also perform research on the efficacy of our products. We encourage people who experience symptoms of venous disease to participate in our clinical trials. These trials help us gather much-needed information, while improving the quality of life of our patients. Browse our website or get in touch with us to find out how you can participate in a particular study.

Doctors may have the opportunity to share their knowledge or ask questions about venous disease by joining The Confluence. This private portal is where discussions and debates take place. We encourage physicians to sign up and be part of this ever-growing community of medical professionals. Members may start a discussion or participate in existing ones. The Confluence is a great place to learn, educate, connect, and collaborate. Doctors talk about a range of topics related to venous disease and share ideas with one another. They discuss issues associated with the diagnosis and treatment of Post-Thrombotic Syndrome and other conditions.

Contact us if you have further questions about PTS and the products we offer.

References

  1. Roumen-Klappe EM, den Heijer M, Janssen MC, et al. The post-thrombotic syndrome: incidence and prognostic value of non-invasive venous examinations in a six-year follow-up study. Thromb Haemost. Oct 2005;94(4):825-830.
  2. Baldwin MJ, Moore HM, Rudarakanchana N, et al. Post-thrombotic syndrome: a clinical review. J Thromb Haemost. May 2013;11(5):795-805.
  3. Kahn SR, Shbaklo H, Lamping DL, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost. Jul 2008;6(7):1105-1112.
  4. Bergan JJ, Schmid-Schonbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med. Aug 3 2006;355(5):488-498.
  5. Franzeck UK, Schalch I, Jager KA, et al. Prospective 12-year follow-up study of clinical and hemodynamic sequelae after deep vein thrombosis in low-risk patients (Zurich study). Circulation. Jan 1 1996;93(1):74-79.
  6. Prandoni P, Kahn SR. Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol. May 2009;145(3):286-295.
  7. Tick LW, Kramer MH, Rosendaal FR, et al. Risk factors for post-thrombotic syndrome in patients with a first deep venous thrombosis. J Thromb Haemost. Dec 2008;6(12):2075-2081.
  8. van Dongen CJ, Prandoni P, Frulla M, et al. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost. May 2005;3(5):939-942.
  9. Becattini C, Agnelli G, Schenone A, et al. Aspirin for preventing the recurrence of venous thromboembolism. N Engl J Med. May 24 2012;366(21):1959-1967.
  10. Chitsike RS, Rodger MA, Kovacs MJ, et al. Risk of post-thrombotic syndrome after subtherapeutic warfarin anticoagulation for a first unprovoked deep vein thrombosis: results from the REVERSE study. J Thromb Haemost. Oct 2012;10(10):2039-2044.
  11. Enden T, Haig Y, Klow NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. Jan 7 2012;379(9810):31-38.
  12. Villalta S, Prandoni P, Cogo A, et al. The utility of non-invasive tests for detection of previous proximal-vein thrombosis. Thromb Haemost. Apr 1995;73(4):592-596.
  13. Kahn SR, Shrier I, Shapiro S, et al. Six-month exercise training program to treat post-thrombotic syndrome: a randomized controlled two-centre trial. CMAJ. Jan 11 2011;183(1):37-44.

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