Postthrombotic Syndrome

Postthrombotic syndromePostthrombotic syndrome is a set of symptoms that may occur after an experience of venous thrombosis. This syndrome may develop in up to half of those   patients who have had a deep vein thrombosis.

Such a situation  if elaborately treated can considerably  enhance the quality of life for patients. The best thing you can do is to try to prevent this complication through consistent care of your veins after deep vein thrombosis.

How the postthrombotic syndrome develops?

Deep veins of the lower limbs have small valves which control the direction of blood flow and help to pump up blood towards the heart. A blood clot in the vein of the lower limbs can cause inflammation and block blood flow, causing damage to these valves. If the valves are damaged, they may become leaky, causing stagnation of fluid and swelling around the ankle. A blood clot that is not completely cured, can also block blood flow. This causes pain, swelling, and sometimes redness of the limb. The deterioration with post-thrombotic syndrome, poor blood flow in the limb may cause ulcers, which can be difficult to treat.

Some patients have a higher risk for developing post-thrombotic syndrome than others. Here are the factors that are  linked to increased risk of post-thrombotic syndrome:

  • Experience of a deep vein thrombosis above the knee
  • More than one previous attack of thrombosis on the same extremity
  • Thrombosis symptoms  persisting  for more than a month after diagnosis
  • Significant overweight, obesity
  • Difficulty maintaining proper levels of anticoagulation for 3 months after diagnosis

Typical symptoms include:

  • Chronic swelling of the lower extremities, which can be worse after walking or prolonged standing and better after resting or putting legs in an elevated position
  • Signs of enlargement of surface veins and the development of secondary varices (varicose veins)
  • Gradually developing trophic changes on the skin, its atrophy, hemosiderin deposition in the form of a rusty pigmentation
  • There may be some fresh petechiae (tiny red to purple spots on the skin or mucosa), often with infected eczematous changes, and extensive non-healing leg ulcers
  • Pain when walking (venous claudication)
  • Feeling of heaviness in the limb, permanent tension, tingling, seizures

How can you prevent the formation of postthrombotic syndrome?

Firstly, it is important to prevent blood clots – thrombosis. Some patients have a higher risk of blood clots, particularly in hospital patients who have had recent surgery or are bedridden. Patients are often equipped with compression stockings and anti-coagulant medications during the hospital stay and after discharge to home care. If you’re in the hospital and none of this is provided by the hospital authority, you should ask your doctor whether you need them to prevent thrombosis. Always tell your doctor about your thrombophilia.

The patient who has a blood clot in the leg, needs to use elastic compression stockings which help keep fluid from pooling around your ankle (edema). Elastic compression stockings are made of a special elastic material. They are very tight at the ankle and gradually up the tightness of stockings ease. The tightness (compression) helps the muscles of the legs to push fluid back in the right direction, improves blood circulation and relieves pain. You should start wearing these stockings as soon as possible after you have been diagnosed with thrombosis and should continue to wear for at least two years.

Compression stockings are manufactured in different strengths (levels of tightness). The level of compression is measured in millimeters of mercury (mm Hg). To get the right level of compression to prevent postthrombotic syndrome (30-40 mm Hg), you’ll need a prescription from your doctor. You can buy these stockings in some pharmacies or in most stores with medical equipment. Sales staff should measure your leg so that you get the right size. Stockings must be worn during the day on the affected lower extremity. Take it off before you go sleep.

Health insurance companies usually cover a new pair of stockings every six months in patients with thrombosis or varicose veins.

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