Complications of Venous Thromboembolism

Post-thrombotic syndrome

Introduction

PTS is the most common complication of DVT and typically causes chronic pain and swelling in the affected leg, and in severe cases can result in venous ulcers1

• After symptomatic DVT, 20–50% of patients develop PTS1
• PTS is associated with substantial morbidity2

The exact cause of PTS is not well understood, but it may result from damage to venous valves, ultimately leading to increased venous pressure.3

Symptoms of PTS include:3

• Chronic pain
• Sensation of heaviness
• Cramps, itching and tingling

Signs of PTS include:3

• Swelling
• Discolouration of the affected leg
• Skin ulceration (severe cases)

Management

In general, patients with PTS are managed using compression therapy and leg elevation.3,4

• Elastic compression stockings can reduce leg swelling, heaviness and aching
• There is some evidence that venoactive or phlebotonic remedies such as aescin or rutoside may reduce the symptoms of PTS, but this remains unproven
• There is no evidence that diuretics are helpful in the management of PTS
• Surgical intervention may be appropriate if patients have chronic obstruction of the veins, sometimes in combination with endophlebectomy, bypass surgery or valvular repair

Chronic thromboembolic pulmonary hypertension

Introduction

CTEPH is a form of pulmonary hypertension caused by partial obstruction of the major pulmonary arteries resulting from an unresolved PE.5

• Occurs as a late complication in 3–4% of patients who survive PE
• Causes the right side of the heart to work harder than normal because of abnormally high blood pressure in the arteries of the lungs. This can lead to heart failure and other serious consequences

Although CTEPH is a serious long-term complication of PE, it can be difficult to diagnose because clinical symptoms and signs are non-specific or absent in early CTEPH. Many of the symptoms of CTEPH are similar to those for acute PE, including:6

• Dyspnoea
• Chest pain with exertion
• Pre-syncope or syncope
• Haemoptysis

Without intervention, the 5-year survival rate once the mean pulmonary artery pressure reaches 40 mm Hg is about 30%.7

CTEPH is generally first identified using echocardiography and can be confirmed by right-sided heart catheterization and perfusion imaging.6

Management

Patients with CTEPH may be managed surgically via pulmonary endarterectomy or, in those for whom this in inappropriate, lung transplantation.6 Riociguat (Adempas^®, Bayer) is approved for the treatment of CTEPH in patients with inoperable or persistent/recurrent CTEPH after pulmonary endarterectomy.8 For patients who have failed on/are not suitable for the above treatment options, drugs approved for idiopathic pulmonary arterial hypertension may be useful for managing the symptoms of CTEPH.9

Learn more about: Cancer-associated thrombosis