Current challenges in the prevention and management of post-thrombotic syndrome—towards improved prevention

Abstract

Post-thrombotic syndrome (PTS) is a common and potentially debilitating complication of deep vein thrombosis (DVT), affecting up to 50% of DVT patients. The consequence of this chronic condition includes reduced quality of life, increased use of the healthcare system and decreased productivity. The societal impact of this condition is projected to increase, given our ageing population and increased burden of thrombotic diseases. Despite significant recent advances in our understanding of PTS, many unanswered questions remain. Currently, there are few effective and proven options for established PTS; hence, the emphasis should be on instituting effective prevention to reduce the progression to PTS. Effective anticoagulation lowers the risk of PTS, with direct oral anticoagulants appearing to outperform vitamin-K antagonists. However, the evidence for elastic compression stockings and endovascular thrombolysis or thrombectomy techniques remains unclear. Accurate identification of individuals at high risk of developing PTS may also improve the targeting of preventative interventions. This review will examine the current body of evidence regarding PTS, with a focus on preventative strategies as well as novel biomarkers.

Sequelae and post‐thrombotic syndrome after venous thromboembolism in acute lymphoblastic leukemia survivors treated on the NOPHO ALL2008 protocol

“…17,18 Post-thrombotic syndrome (PTS) is a condition with varying degrees of venous insufficiency 19 and the most common long-term complication of DVT. [20][21][22] It is a burdensome condition where patients can experience chronic pain, edema, and heaviness of affected limb. 23,24 All potentially leading to severe disability and poor quality of life (QoL), 23,25 particularly in children who have a substantial portion of their lifespan ahead.…”

“…24,[26][27][28] The literature suggests that age, body mass index, proximal DVT, infection, and increased levels of inflammation markers at the time of DVT are all associated with the risk of developing PTS. 21,22,24 The reported prevalence of PTS has shown significant variability, spanning from 0% to 70% in published studies. These studies typically encompass individuals across various age groups with diverse underlying medical conditions, 24,29,30 underscoring the limited research in children and adolescents in general, and specifically in pediatric ALL survivors.…”

“…Post‐thrombotic syndrome (PTS) is a condition with varying degrees of venous insufficiency 19 and the most common long‐term complication of DVT 20–22 . It is a burdensome condition where patients can experience chronic pain, edema, and heaviness of affected limb 23,24 .…”

“…The existing evidence presents small study‐cohorts and very heterogeneous groups of patients 24,26–28 . The literature suggests that age, body mass index, proximal DVT, infection, and increased levels of inflammation markers at the time of DVT are all associated with the risk of developing PTS 21,22,24 …”

Construction of a nomogram model for deep vein thrombosis in patients with tibial plateau fracture based on the Systemic Inflammatory Response Index

“…Some clinical departments may not be able to perform lower limb vascular color Doppler ultrasound examination in a timely manner due to the doctor's experience. Therefore, there is a need for more intuitive, simple, and early predictive indicators for DVT to meet the goal of early prevention and treatment in clinical practice [ 12 ].…”