What are the signs and symptoms of postthrombotic syndrome (PTS) in patients with a history of deep venous thrombosis (DVT)?

Updated: Jun 05, 2019
  • Author: Kaushal (Kevin) Patel, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Postthrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT) that manifests months to many years after the initial event. Symptoms range from mild erythema and localized induration to massive extremity swelling and ulceration, usually exacerbated by standing and relieved by elevation of the extremity. Evaluations of the incidence or of improvements with therapy have been problematic because reporting is not standardized. Furthermore, correlation between objectively measured hemodynamic changes and the severity of PTS is poor. [96]

After symptomatic DVT is treated with anticoagulation, the incidence of PTS at 2 years is 25-50% despite long-term anticoagulation for iliofemoral DVT, and after 7-10 years, the incidence is 70-90%. [97, 98] The only current treatment is use of a compression hose and elevation. In many patients, this is only partly effective in relieving swelling, pain, and venous ulcers. In the United States, the annual direct cost of post–DVT, PTS-related venous ulcers is estimated to be $45 million per year, and 300,000 work days are lost. [99]

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