What is Post-Thrombotic Syndrome?
Post-thrombotic syndrome is a condition that results after deep vein thrombosis.
There are valves present in the veins of arms and legs ensuring the blood flows back to the heart correctly. In deep vein thrombosis, the veins get obstructed and the valve is damaged.
More than one-third of the people with deep vein thrombosis develop a post-thrombotic syndrome that causes redness, swelling, ulcers, and chronic leg pain.(1) Post-thrombotic syndrome is most common in deep vein thrombosis of the legs and affects mobility.
Causes of Post-Thrombotic Syndrome
The main cause of post-thrombotic syndrome is damage to the walls and valves of the veins. This is why deep vein thrombosis needs prompt treatment to prevent damage to the walls and veins of the valve.
Valves are necessary to ensure the upward flow of blood to the heart. They are very fragile and tend to get damaged easily. A damaged valve causes the blood to flow in the wrong way and this is known as reflux. This increases the pressure in the lower part of the legs causing swelling and discomfort.
The veins can get damaged and scarred after deep vein thrombosis. When a person does any physical activity such as walking, the flow of the blood increases in the veins. As the veins are scarred they do not expand as they do normally. Therefore, as the flow of blood increases and they cannot expand there is throbbing pain and swelling in the lower part of the legs.
Eventually, it can lead to damage to the skin on the leg. There is dryness in the skin around the ankles and itching. It may later turn brown, hard, and leathery. Even a minor abrasion can result in a large sore that does not heal. These are called venous ulcers.
In severe cases where the veins are badly damaged and they get completely blocked, no blood is able to flow through them. This is the most serious case of post-thrombotic syndrome.
The risk factors that may increase the chances of developing post-thrombotic syndrome include:(3)
- Being 65 years of age
- Obesity
- Deep vein thrombosis
- Having symptoms of a blood clot after a month
- Not taking blood thinner medication
- Having one or more blood clots in the same vein
Symptoms of Post-Thrombotic Syndrome
The symptoms of post-thrombotic syndrome occur within 3-6 months of developing deep vein thrombosis.(2) The common symptom of the post-thrombotic syndrome include:
- Aching, pain, and swelling in the leg that worsens on standing and walking and is relieved by resting and raising the leg.
- Itchy legs
- Tingling in the legs
- Cramp in the legs
- Ulcers and sores on the legs
- Heaviness of legs
If a person experiences these symptoms and there is a recent history of deep vein thrombosis, it is important to see a doctor as soon as possible. The doctor may be able to diagnose post-thrombotic syndrome on the basis of these symptoms as there is no other diagnostic test for it.
Treatment for Post-Thrombotic Syndrome
Treatment options for post-thrombotic syndrome depend on the severity of the condition. It includes elevation of the affected limb, exercise, and compression therapy or stockings. Blood thinners are also prescribed to prevent the blood from clotting.
Elevation and Exercise: It helps in the return of the blood to the heart. The exercises involved are flexing the ankle and strengthening the calf muscle.
Compression stockings: It is commonly used in the treatment of the post-thrombotic syndrome. They are made up of elastic fiber and provide compression thereby improving the blood flow and reducing pain and swelling. Compression stocking should be of the appropriate size to provide appropriate pressure for the condition. Compression therapy is a common technique that can help in increasing the blood flow and easing post-thrombotic syndrome symptoms.(4)
Surgery: In case of severe post-thrombotic syndrome, thrombectomy may be recommended. It has 2 procedures, in one suction is used to remove the blood clot and another involves breaking the blood clots into small parts to remove them.
Post-thrombotic syndrome can complicate if not treated properly. In such a case, ulcers develop that are difficult to heal and can get infected. This can affect mobility and although rare can lead to sepsis. In such cases, antibiotics may be prescribed to overcome the infection.
Post-thrombotic syndrome is a lifelong condition and also difficult to treat. It can cause discomfort and has greater chances of complications. There is no cure for post-thrombotic syndrome and therefore it’s always better to prevent it from occurring. This can be achieved by prompt treatment for deep vein thrombosis. The quicker the clot is damaged lesser will be the damage to the valves and walls of the veins.
