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2017 ; 34
(1
): 61-67
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Medical Treatment for Postthrombotic Syndrome
#MMPMID28265131
Palacios FS
; Rathbun SW
Semin Intervent Radiol
2017[Mar]; 34
(1
): 61-67
PMID28265131
show ga
Deep vein thrombosis (DVT) is a prevalent disease. About 20 to 30% of patients
with DVT will develop postthrombotic syndrome (PTS) within months after the
initial diagnosis of DVT. There is no gold standard for diagnosis of PTS, but
clinical signs include pitting edema, hyperpigmentation, phlebectatic crown,
venous eczema, and varicose veins. Several scoring systems have been developed
for diagnostic evaluation. Conservative treatment includes compression therapy,
medications, lifestyle modification, and exercise. Compression therapy, the
mainstay and most proven noninvasive therapy for patients with PTS, can be
prescribed as compression stockings, bandaging, adjustable compression wrap
devices, and intermittent pneumatic compression. Medications may be used to both
prevent and treat PTS and include anticoagulation, anti-inflammatories,
vasoactive drugs, antibiotics, and diuretics. Exercise, weight loss, smoking
cessation, and leg elevation are also recommended. Areas of further research
include the duration, compliance, and strength of compression stockings in the
prevention of PTS after DVT; the use of intermittent compression devices; the
optimal medical anticoagulant regimen after endovascular therapy; and the role of
newer anticoagulants as anti-inflammatory agents.
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