PTS - Post-Thrombotic Syndrome



A common and frequent side-effect of a deep vein thrombosis (DVT) is the development of Post-thrombotic Syndrome (PTS) due to the blockage of normal blood flow:

  • An untreated DVT can result in PTS
  • Treatment with anticoagulation alone can lead to PTS
  • Permanent damage can occur
  • PTS can develop in up to 70% of all DVT patients in as little as two months
  • Symptoms include chronic leg pain, fatigue, swelling and skin ulcers

Post-thrombotic syndrome is an under-recognized, but relatively common sequelae, or aftereffect, of having a lower extremity DVT if left untreated. It is likely caused by venous valvular incompetence and persistent obstruction in the vein.

Anticoagulation, or treatment with blood thinners alone, can also lead to PTS because the clot remains in the vein. Contrary to popular belief, anticoagulants do not actively dissolve the clot, they just prevent the clot from growing and greatly reduce the probability that a piece of the clot will break off and travel to the lungs (embolize). The body will eventually dissolve a clot, but often the vein becomes damaged in the meantime. A significant proportion of these patients develop irreversible damage in the affected leg veins and their valves, resulting in abnormal pooling of blood in the leg, chronic leg pain, fatigue, swelling, and, in extreme cases, severe skin ulcers (non healing wounds). Post-thrombotic syndrome develops in up to 50 percent of people with residual blood clot and can occur in as soon as two months. There is increasing evidence that clot removal using an endovascular approach in selected cases of DVT can not only remove the clot quickly, which will greatly reduce the chance of developing PTS, but will also improve the patient’s quality of life.

Endovascular Therapy for LE Venous Thrombotic Disease

Acute complications of DVT include pulmonary embolism and ischemia. Secondary complications include a number of debilitating symptoms collectively referred to as Post-thrombotic Syndrome (PTS).

There is very little evidence showing that anticoagulation therapy alone mitigates against the development of PTS. And endovascular approach to thrombus removal will reduce the risk of valvular damage and subsequent venous occlusive disease.

PTS can develop in 35% to 70% of all patients with a DVT. It is the leading cause of chronic venous disease and accounts for up to 75% of all cases of venous ulcerations.

Reference: Sharafuddin, M, Sun, Shiliang, Hoballah, Jamal, Youness, Fadi, Sharp, William and Roj, Byung-Suk. Endovascular Management of Venous Thrombotic and Occlusive Diseases of the Lower Extremities, J Vasc Interv Radiol 2003; 14:405-423.

Relationship Between Deep Venous Thrombosis and the Postthrombotic Syndrome

Post-thrombotic Syndrome (PTS) is thought to occur due to a combination of venous valve incompetence and persistent obstruction in the vein. 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 $4,700 (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.

Effect of Postthrombotic Syndrome on Health-Related Quality of Life After Deep Vein Thrombosis

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.