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ANTICOAGULATION

Contemporary Issues in the Prevention and Management of Postthrombotic Syndrome

Clinical Pharmacist, University of Utah Thrombosis Service, Department of Pharmacy Services, University of Utah, Salt Lake City, UT

Andrew Freeman, MD

Visiting Clinical Instructor, Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah

Ryan C VanWoerkom, BS

Medical Student, School of Medicine, University of Utah

Matthew T Rondina, MD

Assistant Professor, Internal Medicine, Co-Director, Anticoagulation Services, University Thrombosis Service, Department of Internal Medicine, School of Medicine, University of Utah

Reprints: Dr. Vazquez, University Thrombosis Center, 675 Arapeen Dr., Ste. 100, Salt Lake City, UT 84108, fax 801/585-7978, sara.vazquez{at}hsc.utah.edu

OBJECTIVE: To provide an evidence-based review and clinical summary of postthrombotic syndrome (PTS).

DATA SOURCES: A literature review was performed via MEDLINE (1950–July 1, 2009) and International Pharmaceutical Abstracts (1970–June 2009) searches using the terms post-thrombotic syndrome, post-phlebitic syndrome, deep vein thrombosis, and compression stockings.

DATA SYNTHESIS: PTS is best characterized as a chronic syndrome of clinical signs and symptoms including pain, swelling, parasthesias, and ulceration in the affected limb following deep vein thrombosis (DVT). It occurs in up to half of patients with symptomatic DVT, usually within the first 2 years. Although the pathophysiology of PTS is not well understood, a thrombus may cause venous hypertension and valvular incompetence resulting in edema, tissue hypoxia, and in severe cases, ulceration. Risk factors for PTS include recurrent ipsilateral DVT, obesity, and poor quality of anticoagulant therapy. PTS diagnosis is based on the presence of typical signs and symptoms and may be made using one of several clinical scoring systems. Prevention of PTS should focus on DVT prevention and the use of elastic compression stockings following DVT, while fibrinolysis remains under investigation as an effective method for PTS prevention. The treatment of PTS may include either pharmacologic or mechanical modalities, although none of these regimens has been rigorously tested. Pharmacists have the opportunity to provide more comprehensive antithrombotic management by educating patients and providers on PTS, recommending appropriate preventive therapy, assisting patients in obtaining and adhering to this therapy, and assisting providers with the management of PTS.

CONCLUSIONS: Providers should be proactive in preventing PTS, with pharmacists taking an active role in optimal DVT prevention, identifying patients at risk for PTS, and counseling and directing preventive therapies.

Key Words: compression stockings, deep vein thrombosis, edema, postphlebitic syndrome, postthrombotic syndrome, venous thromboembolism

Published Online, September 8, 2009. www.theannals.com, DOI 10.1345/aph.1M185

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-09-020-H01-P

This article has been cited by other articles:

				S. R. Vazquez and S. R. Kahn Postthrombotic Syndrome Circulation, March 2, 2010; 121(8): e217 - e219. [Full Text] [PDF]