Post-Thrombotic Syndrome

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Post-Thrombotic Syndrome

Postby patoco » Wed Jun 21, 2006 12:01 am

Post-Thrombotic Syndrome

Lymphedema People

http://www.lymphedemapeople.com

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Original Post 05/09/2005 by Mikeski

If one was told they have lymphedema and went thru therapy with 5 compression wraps (that took care of the swelling) should they still have alot of pain in the whole leg? It's a burning sensation throughout my whole leg whether I wear the compression knee highs or not. This treatment was done 3 months ago. I had not worn the compression stocking for about three weeks and have not gotten any more swelling in the leg. I do wear the stocking when I'm on my legs all day, but it still pains me. Could this have anything to do with the DVT's I was diagnosed with. The clots are gone and am off coumadin as well just recently. Please let me know if anyone has experienced this type of annoying pain.

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Response

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Hi Mike

With it only being a short time since all this has happened, I am thinking this is residual from the clots and swelling. You very well could be experiencing something called Post Thrombotic Syndrome.

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Post-Thrombotic Syndrome

What is post-thrombotic syndrome?

Post-thrombotic syndrome is the name used to describe the long-term effects that can occur after you have had a venous thrombosis of the deep veins of the leg. It is caused by damage to the veins, resulting in higher than normal blood pressure. This increased pressure on the vein walls can damage the valves, which normally work to keep blood flowing properly through your veins. Poor blood flow can lead to pain, swelling and leg ulcers, which are some of the symptoms of post-thrombotic syndrome. Post-thrombotic syndrome can cause serious long-term ill health, poor quality of life, and increased costs for the patient and the healthcare system.

Post thrombotic syndrome is common in people who have had thrombosis, whether they are young or old. Generally, 1 out of 3 people who have had thrombosis in the legs will develop some post-thrombotic symptoms within 5 years. Most episodes of post-thrombotic syndrome will occur within 2 years of the thrombosis. People who have thrombosis more than once (recurrent thrombosis) are at higher risk for post-thrombotic syndrome. Thrombosis can go unnoticed, so it is sometimes possible to have post-thrombotic syndrome without being diagnosed with thrombosis first.

http://www.swindon-marlborough.nhs.uk/d ... ag/pts.htm

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Post-thrombotic syndrome may result from some obstructions that remain in the vein or from reflux (backflow of blood) or both (more likely). Obstruction may in turn contribute to reflux. Rate of reflux is highest during the 6 to 12 months after acute DVT. It may occur transiently in up to 23% of DVT patients and may resolve during the follow-up period.

Determinants of Post-Thrombotic Syndrome

The extent of the thrombus may have some part in causing post-thrombotic syndrome, but other factors, too, may be determinants. These are rate of recanalization (formation of new pathways or blood vessels), recurrent thrombotic events, extent of reflux, and venous valve function.

http://www.venous-info.com/handbook/hbk02c.html

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From what I've seen you can experience these residuals for several months after the clots are actually resolved. It's important to let your doctor know what's going on and that they make sure the clots are totally dissolved and don't reoccur.

Pat

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Postthrombotic Syndrome, PTS
Studies show forty to eighty percent of DVT victims eventually develop PTS, with chronic swelling and pain, sometimes with open sores that can cover the lower leg. If you spent weeks with swelling and pain before your DVT was treated, you probably had permanent damage to the veins that will lead to PTS.

One expert (see bibliography, Franzeck) advises wearing compression stockings for five years after DVT to reduce the risk of PTS or reduce the severity of PTS. Some experts advise wearing a compression stocking during the first six months of warfarin treatment. You should certainly be wearing a compression stocking whenever you have any swelling or other DVT symptoms. The stocking can be worn under your regular socks so it doesn't show.

New techniques for treating damaged veins have been developed including ways to reduce the vein diameter and allow valves to close. This can be done with surgical stitches or by installing a sleeve. Before you see a phlebologist, review these techniques at American Venous Forum so you can ask the right questions about the treatment proposed for you. Since these techniques are new, some phlebologists, including some members of the American Venous forum, are not practicing them yet. If you don't have a phlebologist, the AVF website allows you to search for one near you.

http://www.airhealth.org/postthrombotic.html

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Can Compression Stockings Prevent the Post-Thrombotic Syndrome?

Annals of Internal Medicine

The summary below is from the full report titled "Below-Knee Elastic Compression Stockings To Prevent the Post-Thrombotic Syndrome. A Randomized, Controlled Trial." It is in the 17 August 2004 issue of Annals of Internal Medicine (volume 141, pages 249-256). The authors are P. Prandoni, A.W.A. Lensing, M.H. Prins, M. Frulla, A. Marchiori, E. Bernardi, D. Tormene, L. Mosena, A. Pagnan, and A. Girolami.

What is the problem and what is known about it so far?

Deep venous thrombosis (DVT) is a blood clot in a deep vein of the legs. Pieces of the clot can break off and travel through the bloodstream to the lungs. The clots can cause serious symptoms and even death if they are not diagnosed and treated quickly. Even when patients with DVT receive treatment, they may develop sequelae related to impaired blood flow in the leg with the clot. For example, 1 out of 3 patients develop a condition called the post-thrombotic syndrome. Symptoms may include pain, swelling, cramping, numbness, tingling, and itching. Skin on the lower part of the leg may harden or darken. Doctors often recommend that patients with DVT wear special support hose (elastic compression stockings) to prevent these problems. The stockings provide a graduated pressure that is firmer at the bottom and looser at the top to help improve blood flow back to the heart. Unfortunately, few studies show whether the stockings actually prevent the post-thrombotic syndrome.

Why did the researchers do this particular study?

To see whether below-knee elastic compression stockings prevent the post-thrombotic syndrome in patients with DVT.

Who was studied?

180 adults with a first episode of DVT. All received standard treatment with blood-thinning medications for at least 3 to 6 months.

How was the study done?

More than 90% of the patients assigned to the stockings group reported wearing stockings daily during the 2-year period. Five of 90 patients given stockings stopped using them because of itching, redness, or discomfort. Approximately 25% of the patients assigned stockings developed the post-thrombotic syndrome within 2 years compared with approximately 49% of those not assigned stockings. About 13% to 14% of the patients in both groups had repeated episodes of DVT.

What were the limitations of the study?

Both the patients and their doctors knew who wore the stockings.

What are the implications of the study?

While almost half of all patients with DVT develop the post-thrombotic syndrome, wearing below-knee compression stockings can reduce this rate by about 50%.

http://www.annals.org/cgi/content/full/141/4/I-12
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Postby patoco » Mon Mar 24, 2008 11:30 am

Below-Knee Elastic Compression Stockings To Prevent the Post-Thrombotic Syndrome

A Randomized, Controlled Trial

Paolo Prandoni, MD, PhD; Anthonie W.A. Lensing, MD, PhD; Martin H. Prins, MD, PhD; Michela Frulla, MD; Antonio Marchiori, MD; Enrico Bernardi, MD, PhD; Daniela Tormene, MD; Laura Mosena, MD; Antonio Pagnan, MD; and Antonio Girolami, MD

17 August 2004 | Volume 141 Issue 4 | Pages 249-256

Background: Because only limited evidence suggests that elastic stockings prevent the post-thrombotic syndrome in patients with symptomatic deep venous thrombosis (DVT), these stockings are not widely used.

Objective: To evaluate the efficacy of compression elastic stockings for prevention of the post-thrombotic syndrome in patients with proximal DVT.

Design: Randomized, controlled clinical trial.

Setting: University hospital.

Patients: 180 consecutive patients with a first episode of symptomatic proximal DVT who received conventional anticoagulant treatment.

Interventions: Before discharge, patients were randomly assigned to wear or not wear below-knee compression elastic stockings (30 to 40 mm Hg at the ankle) for 2 years. Follow-up was performed for up to 5 years.

Measurements: The presence and severity of the post-thrombotic syndrome were scored by using a standardized scale.

Results: Post-thrombotic sequelae developed in 44 of 90 controls (severe in 10) and in 23 of 90 patients wearing elastic stockings (severe in 3). All but 1 event developed in the first 2 years. The cumulative incidence of the post-thrombotic syndrome in the control group versus the elastic stockings group was 40.0% (95% CI, 29.9% to 50.1%) versus 21.1% (CI, 12.7% to 29.5%) after 6 months, 46.7% (CI, 36.4% to 57.0%) versus 22.2% (CI, 13.8% to 30.7%) after 1 year, and 49.1% (CI, 38.7% to 59.4%) versus 24.5% (CI, 15.6% to 33.4%) after 2 years. After adjustment for baseline characteristics, the hazard ratio for the post-thrombotic syndrome in the elastic stockings group compared with controls was 0.49 (CI, 0.29 to 0.84; P = 0.011).

Limitations: This study lacked a double-blind design.

Conclusions: Post-thrombotic sequelae develop in almost half of patients with proximal DVT. Below-knee compression elastic stockings reduce this rate by approximately 50%.
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