Post Thrombotic Syndrome
What is Post Thrombotic Syndrome?
Thrombosis is basically the medical term for the word “CLOT”, so this syndrome is a mere result of a certain thrombotic disease, namely Deep Vein Thrombosis (DVT).
Having an obstruction on the veins of your arms or legs, it would cause problems to your heart as the outflow of blood would be altered. The immediate signs of this problem are swelling of the extremities and pain.
In some instances, DVT could be acute or can be completely cured but a large chunk of the people affected by it would experience such painful occurrences for the rest of their lives. When the disease is chronic, then it would result in a total blockage of certain veins, causing other nearby veins to stretch for blood to flow through. Going back to Post Thrombotic Syndrome (PTS), it is classified as a mere complication of the disease DVT.
Signs & Symptoms
The symptoms of PTS could disappear and reappear over time. There is no definite time length as to the recurrence of the said symptoms as it varies from one patient to the other since there are different percentage of the blockage of blood in every case. Here are the signs and symptoms of the syndrome:
- Cramping or Aching Pain
- Tingling Sensations or Itchiness
- Edema or Swelling on the affected areas
- Varicose Veins as a result of of the blockage of the blood stream
- Ulcers on the affected areas
- Discoloration of the skin which varies from brownish, reddish, to even bluish in color
- Tiredness or Heaviness
- Skin Hardening
Image 3 – Symptoms of Post thrombotic Syndrome
Causes
The research of the said syndrome is on-going, and as to the causes, it is yet to be determined. Although inflammation clearly has something to do with Post Thrombotic Syndrome as the venous valves from the thrombus itself is damaged.
As the valvular motion is altered with persistent venous blockage, the pressure on the capillaries and veins drastically intensifies as time passes. When the signs and symptoms are manifested, then PTS is taken into consideration.
Risk Factors
In the United States alone, there are an estimated 330,000 people who are affected with Post Thrombotic Syndrome. As to the risks involved, PTS is highly likely on patients who have extensive levels of Deep Vein Thrombosis.
Statistics show that 60% of the people who are treated from DVT would be free from any other succeeding complications, while 36% would experience mild symptoms of PTS, and the remaining 4% would suffer the extreme symptoms of the syndrome. Obese people and those who are 65 years old or older are the ones who are at the highest risk for PTS.
Diagnosis
An ultrasonography of the lower limbs would be done by the physician in order to diagnose PTS. With this procedure, the extent of the clots along with the locations would be determined.
It would take at least three months to diagnose the said syndrome but in some rare cases, Post Thrombotic Syndrome could remain dormant until 3 years. It is strongly advised to have patients remain treated with the same doctor that diagnosed their DVT as he or she would also be able to monitor the progress of it.
Classification of the severity of Post Thrombotic Syndrome is determined by conducting the Villalta Scale, as it is also done to diagnose PTS since the 1990’s. It is the most reliable method in diagnosing such syndrome and is widely accepted in most parts of the world. The Villalta Scale was published on the Journal of Thrombosis and Heamostasis (volume 7, pages 884-888) in the 2009 edition.
Treatment
As blood fails to surge properly upon its return, it is highly recommended to elevate the affected extremities along with compression. With the aid of elastic stockings, circulation would be a lot better, thus treating the edema.
The patient is positioned comfortably on the bed while his or her legs are elevated at 45 degrees higher than the body. This would aid on the hearts workload as the exertion of venous return would not be that forceful than usual. Electrostimulation devices are also good alternatives, and even herbal remedies like horse chestnut and rutosides have also been found to help.
Image 3 – Electrostimulation
However, electrostimulation devices are quite expensive compared to simple elevating, compression, and taking advantage of such herbal remedies. In the hospital setting, the doctor would usually give anticoagulants to help fight the clot.
Prevention
Yes of course, this can be prevented, but not directly though. Since this syndrome can only be found after DVT has occurred, then prevention of it starts from preventing DVT.
For those patients that are hospitalized and have a high risk of developing DVT, preventive measures are done such as early ambulation and in take of anti coagulant drugs are given. Obese people are recommended to loose weight in order to prevent DVT and even PTS from occurring.
As the main problem is the obstruction of the blood flow, pressure on the veins becomes even heavier with added weight. Having the ideal body-mass-index of your current age would prevent not just Deep Vein Thrombosis and Post Thrombotic Syndrome but also other various diseases.
With that being said, it is best to be physically active and to eat a balanced diet for you to maintain the ideal weight and also for those over weight individuals to loose those unwanted body fats in due time.
Pictures
Image 4, 5 – Pics of Post thrombotic Syndrome
References:
- Journal of Thrombosis and Heamostasis 2009 (volume 7, pages 884-888)
- Hratch Karamanoukian, MD, FACS – Member of the American College of Phlebotomy and a diplomate of the American Board of Phlebotomy
