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postphlebitic syndrome; post-thrombotic syndrome

Etiology: 1) thrombophlebitis, complication of deep vein thrombosis 2) risk factors a) older age b) higher body-mass index c) duration of warfarin use (more extensive DVT) d) prior ipsilateral DVT e) common femoral or iliac DVT Epidemiology: 1) common, up to 50% of patients after DVT 2) 10-15% of patients with severe symptoms Clinical manifestations: 1) unilateral leg varicosities 2) only 20% recall a history of deep vein thrombosis 3) heavy, tight, fatigued, aching, or painful extremity a) symptoms begin as the patient arises & assumes an upright position b) symptoms become progressively worse through the day 4) stasis dermatitis 5) ulceration 6) symptoms may persist 2 years after DVT 7) symptoms: a) pain b) cramps c) a sense of heaviness d) pruritus e) paresthesia 8) signs: a) erythema b) edema c) induration d) hyperpigmentation e) venous ectasia f) pain on calf compression Management: 1) anticoagulation for DVT 2) not known if early clot lysis of benefit 3) compression stockings (TED hose) somewhat effective for prevention of postphlebitic syndrome (25% vs 49% of patients with DVT) [2] - one year of therapy non-inferior to 2 years [3,6] - 6-12 months of therapy may be adequate for most patients [4] - ankle pressure, 30-40 mm Hg * compression after DVT reduces residual vein obstruction & thus post-thrombotic syndrome [5]

Related

thrombophlebitis (includes superficial venous thrombosis)

General

syndrome

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Journal Watch 24(19):151-52, 2004 Prandoni P, Lensing AW, Prins MH, Frulla M, Marchiori A, Bernardi E, Tormene D, Mosena L, Pagnan A, Girolami A. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med. 2004 Aug 17;141(4):249-56. PMID: 15313740 - Ginsberg JS. Routine stocking therapy after deep venous thrombosis: a clinical dilemma. Ann Intern Med. 2004 Aug 17;141(4):314-5. No abstract available. PMID: 15313748
  3. Mol GC et al. One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): Randomised controlled trial. BMJ 2016 May 31; 353:i2691 PMID: 27245485 Free PMC Article
  4. Ten Cate-Hoek AJ, Amin EE, Bouman AC et al. Individualized versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL DVT): A multicenter, randomized, single-blind, allocation-concealed, non-inferiority trial. Lancet Haematol 2018 Jan; 5:e25 PMID: 29217387
  5. Amin EE, Bistervels IM, Meijer K et al. Residual vein occlusion in relation to immediate compression and postthrombotic syndrome in deep vein thrombosis. Blood 2018 Sep 20 PMID: 30237155 http://www.bloodjournal.org/content/early/2018/09/24/blood-2018-03-836783
  6. Meng J et al. Is it necessary to wear compression stockings and how long should they be worn for preventing post thrombotic syndrome? A meta-analysis of randomized controlled trials. Thromb Res 2023 May; 225:79 PMID: 37030189 Free article https://www.thrombosisresearch.com/article/S0049-3848(23)00090-7/fulltext