Table 2.

Suggested approaches to prevent and treat PTS

Prevention
Prevent the occurrence of DVT with the use of thromboprophylaxis in high-risk patients and settings as recommended in evidence-based consensus guidelines.
Prevent recurrent ipsilateral DVT by providing anticoagulation of appropriate intensity and duration for the initial DVT and by targeted use of appropriate thromboprophylaxis if long-term anticoagulation is discontinued.
In patients whose DVT is treated with a vitamin K antagonist, frequent, regular INR monitoring should be performed to avoid subtherapeutic INRs, especially in the first 3 months of treatment.
Do not routinely prescribe elastic compression stockings (ECS) for 2 years to all DVT patients. However, it is reasonable to prescribe a trial of 20-30–mm Hg or 30-40–mm Hg below-knee ECS to patients who have residual leg swelling or discomfort after DVT, and to continue wearing them for as long as the patient derives symptomatic benefit or is able to tolerate them.
The role of thrombolysis for the prevention of PTS is not yet established. Pharmacomechanical catheter-directed thrombolysis is currently undergoing evaluation in large, well-designed trials. At present, selection of patients for these techniques should be done on an individual patient basis, and mainly considered for those with extensive thrombosis, recent symptom onset, low risk of bleeding, and long life expectancy, seen at experienced centers.
Treatment
Use ECS to reduce edema and improve PTS symptoms such as leg pain and heaviness. If 20-30–mm Hg stockings do not adequately control PTS symptoms, a stronger pressure stocking (30-40 mm Hg; or 40-50 mm Hg) can be tried.
Consider a trial of intermittent pneumatic compression units in patients with moderate to severe PTS.
Consider prescribing a supervised exercise training program with leg strengthening and aerobic components for ≥6 months to patients with PTS who can tolerate it.
Until more safety and effectiveness data are available, do not use venoactive drugs to treat PTS.
A multidisciplinary approach should be used for venous ulcer management, which typically consists of compression therapy, skin care, and topical dressings.
In patients with symptoms of upper extremity PTS, a 20-30–mm Hg or 30-40–mm Hg compression sleeve should be tried.
Providing patient support and ongoing follow-up is an important component of PTS management.