Contemporary Issues in the Prevention and Management of Postthrombotic Syndrome
Identifieur interne : 002A30 ( Pmc/Curation ); précédent : 002A29; suivant : 002A31Contemporary Issues in the Prevention and Management of Postthrombotic Syndrome
Auteurs : Sara R. Vazquez ; Andrew Freeman ; Ryan C. Vanwoerkom ; Matthew T. RondinaSource :
- The Annals of pharmacotherapy [ 1060-0280 ] ; 2009.
Abstract
To provide an evidence-based review and clinical summary of postthrombotic syndrome (PTS).
A literature review was performed via MEDLINE (1950–July 1, 2009) and
PTS is best characterized as a chronic syndrome of clinical signs and symptoms including pain, swelling, parasthesias, and ulceration in the affected limb following deep vein thrombosis (DVT). It occurs in up to half of patients with symptomatic DVT, usually within the first 2 years. Although the pathophysiology of PTS is not well understood, a thrombus may cause venous hypertension and valvular incompetence resulting in edema, tissue hypoxia, and in severe cases, ulceration. Risk factors for PTS include recurrent ipsilateral DVT, obesity, and poor quality of anticoagulant therapy. PTS diagnosis is based on the presence of typical signs and symptoms and may be made using one of several clinical scoring systems. Prevention of PTS should focus on DVT prevention and the use of elastic compression stockings following DVT, while fibrinolysis remains under investigation as an effective method for PTS prevention. The treatment of PTS may include either pharmacologic or mechanical modalities, although none of these regimens has been rigorously tested. Pharmacists have the opportunity to provide more comprehensive antithrombotic management by educating patients and providers on PTS, recommending appropriate preventive therapy, assisting patients in obtaining and adhering to this therapy, and assisting providers with the management of PTS.
Providers should be proactive in preventing PTS, with pharmacists taking an active role in optimal DVT prevention, identifying patients at risk for PTS, and counseling and directing preventive therapies.
Url:
DOI: 10.1345/aph.1M185
PubMed: 19737994
PubMed Central: 3245967
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<author><name sortKey="Vazquez, Sara R" sort="Vazquez, Sara R" uniqKey="Vazquez S" first="Sara R" last="Vazquez">Sara R. Vazquez</name>
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<author><name sortKey="Freeman, Andrew" sort="Freeman, Andrew" uniqKey="Freeman A" first="Andrew" last="Freeman">Andrew Freeman</name>
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<author><name sortKey="Vanwoerkom, Ryan C" sort="Vanwoerkom, Ryan C" uniqKey="Vanwoerkom R" first="Ryan C" last="Vanwoerkom">Ryan C. Vanwoerkom</name>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>OBJECTIVE</title>
<p id="P1">To provide an evidence-based review and clinical summary of postthrombotic syndrome (PTS).</p>
</sec>
<sec id="S2"><title>DATA SOURCES</title>
<p id="P2">A literature review was performed via MEDLINE (1950–July 1, 2009) and <italic>International Pharmaceutical Abstracts</italic>
(1970–June 2009) searches using the terms post-thrombotic syndrome, post-phlebitic syndrome, deep vein thrombosis, and compression stockings.</p>
</sec>
<sec id="S3"><title>DATA SYNTHESIS</title>
<p id="P3">PTS is best characterized as a chronic syndrome of clinical signs and symptoms including pain, swelling, parasthesias, and ulceration in the affected limb following deep vein thrombosis (DVT). It occurs in up to half of patients with symptomatic DVT, usually within the first 2 years. Although the pathophysiology of PTS is not well understood, a thrombus may cause venous hypertension and valvular incompetence resulting in edema, tissue hypoxia, and in severe cases, ulceration. Risk factors for PTS include recurrent ipsilateral DVT, obesity, and poor quality of anticoagulant therapy. PTS diagnosis is based on the presence of typical signs and symptoms and may be made using one of several clinical scoring systems. Prevention of PTS should focus on DVT prevention and the use of elastic compression stockings following DVT, while fibrinolysis remains under investigation as an effective method for PTS prevention. The treatment of PTS may include either pharmacologic or mechanical modalities, although none of these regimens has been rigorously tested. Pharmacists have the opportunity to provide more comprehensive antithrombotic management by educating patients and providers on PTS, recommending appropriate preventive therapy, assisting patients in obtaining and adhering to this therapy, and assisting providers with the management of PTS.</p>
</sec>
<sec id="S4"><title>CONCLUSIONS</title>
<p id="P4">Providers should be proactive in preventing PTS, with pharmacists taking an active role in optimal DVT prevention, identifying patients at risk for PTS, and counseling and directing preventive therapies.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article" xml:lang="en"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9203131</journal-id>
<journal-id journal-id-type="pubmed-jr-id">1999</journal-id>
<journal-id journal-id-type="nlm-ta">Ann Pharmacother</journal-id>
<journal-title-group><journal-title>The Annals of pharmacotherapy</journal-title>
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<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
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<title-group><article-title>Contemporary Issues in the Prevention and Management of Postthrombotic Syndrome</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Vazquez</surname>
<given-names>Sara R</given-names>
</name>
<degrees>BCPS, PharmD</degrees>
<role>Clinical Pharmacist</role>
<aff id="A1">University of Utah Thrombosis Service, Department of Pharmacy Services, University of Utah, Salt Lake City, UT</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Freeman</surname>
<given-names>Andrew</given-names>
</name>
<degrees>MD</degrees>
<role>Visiting Clinical Instructor</role>
<aff id="A2">Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah</aff>
</contrib>
<contrib contrib-type="author"><name><surname>VanWoerkom</surname>
<given-names>Ryan C</given-names>
</name>
<degrees>BS</degrees>
<role>Medical Student</role>
<aff id="A3">School of Medicine, University of Utah</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Rondina</surname>
<given-names>Matthew T</given-names>
</name>
<degrees>MD</degrees>
<role>Assistant Professor</role>
<aff id="A4">Internal Medicine, Co-Director, Anticoagulation Services, University Thrombosis Service, Department of Internal Medicine, School of Medicine, University of Utah</aff>
</contrib>
</contrib-group>
<author-notes><corresp id="FN1">Reprints: Dr. Vazquez, University Thrombosis Center, 675 Arapeen Dr., Ste. 100, Salt Lake City, UT 84108, fax 801/585-7978, <email>sara.vazquez@hsc.utah.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>21</day>
<month>3</month>
<year>2011</year>
</pub-date>
<pub-date pub-type="epub"><day>8</day>
<month>9</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="ppub"><month>11</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>26</day>
<month>12</month>
<year>2011</year>
</pub-date>
<volume>43</volume>
<issue>11</issue>
<fpage>1824</fpage>
<lpage>1835</lpage>
<abstract><sec id="S1"><title>OBJECTIVE</title>
<p id="P1">To provide an evidence-based review and clinical summary of postthrombotic syndrome (PTS).</p>
</sec>
<sec id="S2"><title>DATA SOURCES</title>
<p id="P2">A literature review was performed via MEDLINE (1950–July 1, 2009) and <italic>International Pharmaceutical Abstracts</italic>
(1970–June 2009) searches using the terms post-thrombotic syndrome, post-phlebitic syndrome, deep vein thrombosis, and compression stockings.</p>
</sec>
<sec id="S3"><title>DATA SYNTHESIS</title>
<p id="P3">PTS is best characterized as a chronic syndrome of clinical signs and symptoms including pain, swelling, parasthesias, and ulceration in the affected limb following deep vein thrombosis (DVT). It occurs in up to half of patients with symptomatic DVT, usually within the first 2 years. Although the pathophysiology of PTS is not well understood, a thrombus may cause venous hypertension and valvular incompetence resulting in edema, tissue hypoxia, and in severe cases, ulceration. Risk factors for PTS include recurrent ipsilateral DVT, obesity, and poor quality of anticoagulant therapy. PTS diagnosis is based on the presence of typical signs and symptoms and may be made using one of several clinical scoring systems. Prevention of PTS should focus on DVT prevention and the use of elastic compression stockings following DVT, while fibrinolysis remains under investigation as an effective method for PTS prevention. The treatment of PTS may include either pharmacologic or mechanical modalities, although none of these regimens has been rigorously tested. Pharmacists have the opportunity to provide more comprehensive antithrombotic management by educating patients and providers on PTS, recommending appropriate preventive therapy, assisting patients in obtaining and adhering to this therapy, and assisting providers with the management of PTS.</p>
</sec>
<sec id="S4"><title>CONCLUSIONS</title>
<p id="P4">Providers should be proactive in preventing PTS, with pharmacists taking an active role in optimal DVT prevention, identifying patients at risk for PTS, and counseling and directing preventive therapies.</p>
</sec>
</abstract>
<kwd-group><kwd>compression stockings</kwd>
<kwd>deep vein thrombosis</kwd>
<kwd>edema</kwd>
<kwd>postphlebitic syndrome</kwd>
<kwd>postthrombotic syndrome</kwd>
<kwd>venous thromboembolism</kwd>
</kwd-group>
<funding-group><award-group><funding-source country="United States">National Center for Research Resources : NCRR</funding-source>
<award-id>KL2 RR025763-02 || RR</award-id>
</award-group>
<award-group><funding-source country="United States">National Heart, Lung, and Blood Institute : NHLBI</funding-source>
<award-id>K23 HL092161-02 || HL</award-id>
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</funding-group>
</article-meta>
</front>
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