Post-Thrombotic Syndrome

If you’ve had a blood clot in a vein, also known as deep vein thrombosis (DVT), you could have symptoms that linger after you’ve recovered from the clot. It’s a condition called post-thrombotic syndrome (PTS).

It usually affects veins in your leg, but it’s also possible in your arm.

Signs of the condition, like skin ulcers on your leg or swelling, can be painful or uncomfortable.

They can happen a few months or up to 2 years after you have DVT. They could last for years or stick around for good.

How Common Is PTS?

PTS is common. It affects approximately 330,000 Americans.

About 20%-40% of people who have had a bout of DVT in one of their lower limbs will get it later on. About 10% of people who get it have serious signs, such as leg ulcers.

What Causes PTS?

Your leg veins have tiny valves inside them. These valves help blood move back up your legs to your heart. A DVT blood clot in your vein can damage and weaken these valves. They can become leaky or weak.

Blood can move in the wrong direction and then pool inside your leg. A buildup of blood, fluid, and pressure in your leg causes PTS.

Who Gets PTS?

Men and women both get PTS. It can happen at any age, but it’s more common if you’re 65 or older.

Your risk for this condition may go up if you’ve had:

  • Proximal DVT, or blood clots in any of the deep veins above your knee
  • DVT more than once
  • A blood clot in the same leg twice or more
  • A blood clot that caused any symptoms
  • Any increased pressure in your leg veins

PTS is also more likely if you:

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Symptoms

PTS symptoms can be uncomfortable or even painful. They can lower your quality of life by making it hard for you to get around or be active.

They can be mild or serious. You might feel them all the time, or they may come and go.

Not everyone has every one, but they can include:

  • Aches
  • Heavy feeling
  • Pain that worsens when you stand and feels better when you raise the leg or rest
  • Itching
  • Tingling
  • Cramping
  • Swelling
  • Leg ulcers
  • Blue or brown color on skin
  • Dry, flaky skin
  • Newly developed varicose veins
  • Hardened skin
  • Pain that’s constant or lasts

Diagnosis

Your doctor can examine you and measure your symptoms using a scale called a Villalta score. If your score is 15 or higher, you have severe PTS.

You may need some tests to confirm your diagnosis:

  • Blood tests to check for blood clotting problems
  • Ultrasound scans to look for valve problems in your veins

Treatment

Compression stockings. The main way to treat PTS is to wear an elastic compression stocking. They boost blood flow through your veins, ease pain, and reduce swelling.

They’re available over the counter, but prescription versions apply more pressure to your leg. Wear yours every day. You don’t have to sleep in it.

Some people find compression stockings uncomfortable or ugly, so they don’t want to wear them. But they now come in many fits, styles, and colors, so you can find one that feels more comfortable and attractive to you.

IPC device. Your doctor may prescribe an intermittent pneumatic compression (IPC) device to wear on your leg to apply pressure to your veins. It helps improve blood flow to ease pain and swelling.

Skin care. Keep your skin moistened with a lubricant like petroleum jelly. You can also protect it with zinc oxide cream, which forms a barrier to protect your skin. Your doctor may also prescribe steroid cream or ointments.

Leg ulcer treatments. If you develop leg ulcers, you might need to see a specialist, such as a dermatologist (skin doctor) or vascular surgeon, or work with a wound-care nurse.

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To treat them:

  • Use compression stockings
  • Elevate your leg
  • Use ointments on your skin
  • Wrap the area in bandages

A medication called pentoxifylline may also improve blood flow and get more oxygen to the area where you have an ulcer. If these treatments don’t work, you may need surgery.

Surgery. For people with severe symptoms who don’t find relief with compression treatment, surgery may be the next step. A surgeon can put a stent inside your vein to treat the blockage or do venous bypass surgery.

Prevention and Lifestyle

How can you help prevent PTS? Here are a few tips:

Prevent blood clots after surgery. Use compression stockings or compression devices as directed after any procedure, especially while you’re in bed at the hospital or at home. Get up and move around as soon as you’re able.

Stop clots from coming back. If you have more than one clot in the same vein, it raises your risk of PTS. Take blood thinners as your doctor tells you so a new clot doesn’t form. Take your blood thinners until your doctor says you can stop.

Lose weight if you’re overweight. Extra weight puts pressure on your veins and makes PTS more likely.

Get regular checkups. If you’ve had DVT, see your doctor as scheduled to check for any signs of PTS early.

If you develop PTS symptoms, these tips can help you manage them:

Elevate. Prop up your leg a few times a day. Keep it raised whenever you lie down.

Exercise. Take daily walks if you can. This can build muscle strength in your leg. Flex your ankles each day to work your calf muscles. Talk to your doctor about safe ways to exercise with PTS.

Stay out of the heat. Don’t spend too much time in hot temperatures if you can avoid it.

WebMD Medical Reference Reviewed by Carmelita Swiner, MD on March 20, 2020

Sources

SOURCES:

VascularCures.org: “What Is Post-Thrombotic Syndrome (PTS)?”

National Blood Clot Alliance: “Post-Thrombotic Syndrome.”

Cedars-Sinai Hospital: “Post-Thrombotic Syndrome.”

American Society of Hematology: “How I Treat in Brief: Managing Post-Thrombotic Syndrome.”

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