postphlebitic syndrome; post-thrombotic syndrome
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Etiology
- thrombophlebitis, complication of deep vein thrombosis
- risk factors
- older age
- higher body-mass index
- duration of warfarin use (more extensive DVT)
- prior ipsilateral DVT
- common femoral or iliac DVT
Epidemiology
- common, up to 50% of patients after DVT
- 10-15% of patients with severe symptoms
Clinical manifestations
- unilateral leg varicosities
- only 20% recall a history of deep vein thrombosis
- heavy, tight, fatigued, aching, or painful extremity
- symptoms begin as the patient arises & assumes an upright position
- symptoms become progressively worse through the day
- stasis dermatitis
- ulceration
- symptoms may persist 2 years after DVT
- symptoms:
- pain
- cramps
- a sense of heaviness
- pruritus
- paresthesia
- signs:
- erythema
- edema
- induration
- hyperpigmentation
- venous ectasia
- pain on calf compression
Management
- anticoagulation for DVT
- not known if early clot lysis of benefit
- compression stockings (TED hose) somewhat effective for prevention of postphlebitic syndrome (25% vs 49% of patients with DVT)[2]
* compression after DVT reduces residual vein obstruction & thus post-thrombotic syndrome[5]
More general terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 2.0 2.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/15313748 - ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/27245485 Free PMC Article
- ↑ 4.0 4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/29217387
- ↑ 5.0 5.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30237155 <Internet> http://www.bloodjournal.org/content/early/2018/09/24/blood-2018-03-836783
- ↑ 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/37030189 Free article https://www.thrombosisresearch.com/article/S0049-3848(23)00090-7/fulltext