Post-Thrombotic Syndrome (PTS)

Within a short time of diagnosis, a substantial set of DVT patients will suffer the debilitating effects of Post-thrombotic Syndrome (PTS); PTS is caused by loss of valvular function combined with venous obstruction.

The quality of life of those patients who progress to PTS is substantially lower than that of other DVT patients.

Post-thrombotic Syndrome (PTS) is thought to occur due to a combination of venous valve incompetence and persistent obstruction. There is little correlation between the severity of DVT and the occurrence of PTS. The authors note studies of DVT patients in which the incidence of PTS was 17.3% after one year up to 29% after eight years. Studies cited note the average cost of treating PTS was $4700 (1997), with direct costs of treating chronic venous insufficiency in the US at $300 million (2001). The occurrence of PTS in high risk DVT patients can be reduced with thromboprophylaxis. Thrombolytic therapy in addition to anticoagulation results in better patency and valve function preservation than anticoagulation alone.
Reference: Kahn, SR and Ginsberg, JS. Relationship Between Deep Venous Thrombosis and the Postthrombotic Syndrome. Arch Intern Med 2004; 164:17-26.

Forty-one patients with diagnosed DVT were evaluated for quality of life (QOL) measures with validated generic (SF-36) and disease specific (VEINES) questionnaires. A clinically validated method of determining the signs and symptoms of Post-thrombotic Syndrome (PTS) was also used. PTS was present in nineteen of the patients (46%). There was no statistical difference in the generic SF-36 QOL measures, while the disease specific VEINES scores were significantly worse for those patients with PTS. Patients with severe PTS had significantly worse VEINES QOL scores than those with mild or moderate PTS.
Reference: Kahn, SR, Hirsch, A and Shrier, I. Effect of Postthrombotic Syndrome on Health-Related Quality of Life After Deep Vein Thrombosis. Arch Intern Med 2002; 62:1144-1148.

One hundred and eighty patients with confirmed DVT were randomized to receive compression stocking and individualized anticoagulation therapy or anticoagulation therapy alone. In the control and experimental groups, at two years follow-up, PTS occurrence was 49.1% and 24.5%, respectively. Only recurrent ipsilateral DVT was correlated to developing PTS.
Reference: Prandoni, P, Lensing, AW, Prins, MH, et al. Below-Knee Elastic Compression Stockings to Prevent Post-Thrombotic Syndrome: A Randomized, Controlled Trial. Ann Intern Med 2004; 141:249-256.

Key Learnings:

  • PTS is likely caused by venous valvular incompetence coupled with persistent obstruction
  • Studies demonstrate occurrence rates of 17% to 50% for PTS within one year of DVT onset
  • There is no correlation between the severity of DVT and the occurrence of PTS
  • However, there is a correlation between the severity of DVT and the severity of PTS
  • Thrombolytic therapy, in combination with anticoagulation, results in superior patency and preservation of valve function compared to anticoagulation therapy alone
  • The QOL of DVT patients with PTS is significantly lower than DVT patients without PTS
  • Once PTS occurs, the methods of treatment are limited