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Review

Prevention and Management of the Post-Thrombotic Syndrome

1
Division of Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
2
Center for Clinical Epidemiology, Jewish General Hospital/Lady Davis Institute; Division of Internal Medicine, Department of Medicine, McGill University, Montreal, QC H3A 1A1, Canada
3
Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON M4N 3M5, Canada
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(4), 923; https://doi.org/10.3390/jcm9040923
Received: 6 February 2020 / Revised: 19 March 2020 / Accepted: 24 March 2020 / Published: 27 March 2020
(This article belongs to the Special Issue Venous Thromboembolism — Diagnosis, Prevention and Treatment)
The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency secondary to prior deep vein thrombosis (DVT). It affects up to 50% of patients after proximal DVT. There is no effective treatment of established PTS and its management lies in its prevention after DVT. Optimal anticoagulation is key for PTS prevention. Among anticoagulants, low-molecular-weight heparins have anti-inflammatory properties, and have a particularly attractive profile. Elastic compression stockings (ECS) may be helpful for treating acute DVT symptoms but their benefits for PTS prevention are debated. Catheter-directed techniques reduce acute DVT symptoms and might reduce the risk of moderate–severe PTS in the long term in patients with ilio-femoral DVT at low risk of bleeding. Statins may decrease the risk of PTS, but current evidence is lacking. Treatment of PTS is based on the use of ECS and lifestyle measures such as leg elevation, weight loss and exercise. Venoactive medications may be helpful and research is ongoing. Interventional techniques to treat PTS should be reserved for highly selected patients with chronic iliac obstruction or greater saphenous vein reflux, but have not yet been assessed by robust clinical trials. View Full-Text
Keywords: deep vein thrombosis; post-thrombotic syndrome; elastic compression stockings; catheter-directed thrombolysis; low-molecular-weight heparins deep vein thrombosis; post-thrombotic syndrome; elastic compression stockings; catheter-directed thrombolysis; low-molecular-weight heparins
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MDPI and ACS Style

Makedonov, I.; Kahn, S.R.; Galanaud, J.-P. Prevention and Management of the Post-Thrombotic Syndrome. J. Clin. Med. 2020, 9, 923. https://doi.org/10.3390/jcm9040923

AMA Style

Makedonov I, Kahn SR, Galanaud J-P. Prevention and Management of the Post-Thrombotic Syndrome. Journal of Clinical Medicine. 2020; 9(4):923. https://doi.org/10.3390/jcm9040923

Chicago/Turabian Style

Makedonov, Ilia, Susan R. Kahn, and Jean-Philippe Galanaud. 2020. "Prevention and Management of the Post-Thrombotic Syndrome" Journal of Clinical Medicine 9, no. 4: 923. https://doi.org/10.3390/jcm9040923

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