関: postthrombotic syndrome

WordNet

ride Western style and bob up and down in the saddle in rhythm with a horses trotting gait
an upright consisting of a piece of timber or metal fixed firmly in an upright position; "he set a row of posts in the ground and strung barbwire between them"
the delivery and collection of letters and packages; "it came by the first post"; "if you hurry youll catch the post"
a pole or stake set up to mark something (as the start or end of a race track); "a pair of posts marked the goal"; "the corner of the lot was indicated by a stake" (同)stake
the position where someone (as a guard or sentry) stands or is assigned to stand; "a soldier manned the entrance post"; "a sentry station" (同)station
mark or expose as infamous; "She was branded a loose woman" (同)brand
transfer (entries) from one account book to another (同)carry
place so as to be noticed; "post a sign"; "post a warning at the dump" (同)put_up
affix in a public place or for public notice; "post a warning"
assign to a post; put into a post; "The newspaper posted him in Timbuktu"
display, as of records in sports games
enter on a public list
publicize with, or as if with, a poster; "Ill post the news on the bulletin board"
United States manufacturer of breakfast cereals and Postum (1854-1914) (同)C. W. Post, Charles William Post
United States female author who wrote a book and a syndicated newspaper column on etiquette (1872-1960) (同)Emily Post, Emily Price Post
United States aviator who in 1933 made the first solo flight around the world (1899-1935) (同)Wiley Post
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
(bookkeeping) a listing on the companys records; "the posting was made in the cash account"
publicly announced; "the posted speed limit"

PrepTutorEJDIC

〈C〉(木・金属・石などの)『柱』,『支柱』,くい / 《the ~》(競馬の)出発標,決勝標 / 〈C〉《話》(ラグビーなどの)ゴールポスト(goalpost) / (柱・壁などに)〈掲示物〉‘を'『張る』,張り出す《+『名』〈掲示物〉+『on』+『名』》;(掲示物を)〈柱・壁など〉‘に'張る《+『名』+『with』+『名』〈掲示物〉》 / (掲示して)…‘を'公表する,公示する / 《通例受動態で》(…として)…‘を'掲示(発表)する《+『名』+『as』+『現分』(過分)》
(兵士・警官・看護婦などの)『部署』,『持ち場』 / (軍隊の)駐屯(ちゅうとん)地,駐留地,兵営地 / (指名・任命された)『地位』,職 / (またtrading post)(未開地などの)交易所 / 〈兵士・警官・看護婦など〉‘を'配置する / 《通例受動態で》《おもに英》(…に)〈人〉‘を'任命する《+『名』+『to』+『名』》
〈U〉《おもに英》『郵便』[制度] / 《おもに英》《単数形で》(郵便物の1回の)『集配』,『配達』,便;(1回で集配・配達される)郵便物(《米》mail) / 《the ~》《おもに英》郵便局(post office);ポスト,郵便箱(《米》mailbox) / 〈C〉(昔,郵便物の中断所にした)駅,宿,宿場 / 《おもに英》〈郵便物〉‘を'郵便局に出す,ポストに入れる(《米》mail)《+『off』+『名』+『,』『名』+『off』》 / 《『post』+『名』〈間〉〈人〉+『名』〈直〉=『post』+『名』+『to』+『名』〈人〉》〈人〉‘に'〈手紙など〉‘を'郵便で送る(《米》mail)
(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
《おもに英》(特に軍職に)任命すること

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/01/19 22:59:33」(JST)

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Post-thrombotic syndrome (PTS, also called postphlebitic syndrome and venous stress disorder) is the signs and symptoms that may occur as long-term complications of deep vein thrombosis (DVT).

Incidence

PTS can affect 23-60% of patients in the two years following DVT of the leg. Of those, 10% may go on to develop severe PTS, involving venous ulcers.^[1]

Socioeconomic impact

PTS lowers patients' quality of life after DVT, specifically with regards to physical and psychological symptoms and limitations in daily activities.^[2]^[3]^[4] Secondly, the treatment of PTS adds significantly to the cost of treating DVT. The annual health care cost of PTS in the United States has been estimated at $200 million, with costs over $3800 per patient in the first year alone, and increasing with disease severity.^[1]^[5] PTS also causes lost work productivity: patients with severe PTS and venous ulcers lose up to 2 work days per year.^[6]

Signs and symptoms

Signs and symptoms of PTS in the leg may include:^[7]

pain (aching or cramping)
heaviness
itching or tingling
swelling (edema)
varicose veins
brownish or reddish skin discoloration
ulcer

These signs and symptoms may vary among patients and over time. With PTS, these symptoms typically are worse after walking or standing for long periods of time and improve with resting or elevating the leg.^[7]

Diagnosis

When a physician finds a DVT in the clinical history of their patient, a post-thrombotic syndrome will be possible if the patient has suggestive symptoms. A Lower limbs venous ultrasonography must be performed to evaluate the situation: the degree of obstruction by clots, the location of these clots, the detection of deep and/or superficial venous insufficiency.^[8]^[9] Since signs and symptoms of DVT and PTS may be quite similar, a diagnosis of PTS should be delayed for 3–6 months after DVT diagnosis so that an appropriate diagnosis can be made.^[7]

Cause

Despite ongoing research, the cause of PTS is not entirely clear. Inflammation is thought to play a role ^[10]^[11] as well as damage to the venous valves from the thrombus itself. This valvular incompetence combined with persistent venous obstruction from thrombus increases the pressure in veins and capillaries. Venous hypertension induces a rupture of small superficial veins, subcutaneous hemorrhage^[12] and an increase of tissue permeability. That is manifested by pain, swelling, discoloration, and even ulceration.^[13]

Risk factors

The following factors increase the risk of developing PTS:^[14]^[15]^[16]^[17]^[18]^[19]^[20]

age > 65
proximal DVT
a second DVT in same leg as first DVT (recurrent ipsilateral DVT)
persistent DVT symptoms 1 month after DVT diagnosis
obesity
poor quality of anticoagulation control (i.e. dose too low) during the first 3 months of treatment

Prevention

Prevention of PTS begins with prevention of initial and recurrent DVT. For hospitalized patients at high-risk of DVT, prevention methods may include early ambulation, use of compression stockings or electrostimulation devices, and/or anticoagulant medications.^[21]

Increasingly, catheter-directed thrombolysis has been employed. This is a procedure in which interventional radiology will break up a clot using a variety of methods.

For patients who have already had a single DVT event, the best way to prevent a second DVT is appropriate anticoagulation therapy.^[22]

A second prevention approach may be weight loss for those who are overweight or obese. Increased weight can put more stress and pressure on leg veins, and can predispose patients to developing PTS.^[18]

Finally, some data suggest that the use of elastic compression stockings for up to 2 years post-DVT can be an effective method of PTS prevention,^[23]^[24] while some data suggest otherwise.^[25]^[26]

Treatment

Treatment options for PTS include proper leg elevation, compression therapy with elastic stockings, or electrostimulation devices, herbal remedies (such as horse chestnut, rutosides, pentoxifylline), and wound care for leg ulcers.^[7]^[27] PTS in the legs is often exacerbated by blockage of draining veins in the pelvis or abdomen (iliac veins and IVC), and opening of these veins (by application of angioplasty and vascular stents by an experienced physician) can provide significant relief of swelling and healing of skin ulcers.

Compression bandages are useful to treat edemas.^[12]

Upper-extremities

Patients with upper-extremity DVT may develop upper-extremity PTS, but the incidence is lower than that for lower-extremity PTS (15-25%).^[28]^[29] There are no established treatment or prevention methods, but patients with upper-extremity PTS may wear a compression sleeve for persistent symptoms.^[22]

Research directions

The field of PTS still holds many unanswered questions that are important targets for more research. Those include

fully defining the pathophysiology of PTS, including the role of inflammation and residual thrombus after completion of an appropriate duration of anticoagulant therapy
developing a PTS risk prediction model
role of thrombolysis ("clot-busting" drugs) in PTS prevention
defining the true efficacy of elastic compression stockings for PTS prevention (and if effective, elucidating the minimum compression strength necessary and the optimal timing and duration of compression therapy)
whether PTS prevention methods are necessary for patients with asymptomatic or distal DVT
additional treatment options for PTS with demonstrated safety and efficacy (compression and pharmacologic therapies)^{[citation needed]}

References

^ ^a ^b Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolysis 2009; 28: 465-76.
^ Kahn SR, Hirsch A, Shrier I. Effect of postthrombotic syndrome on health-related quality of life after deep venous thrombosis. Arch Intern Med 2002;162:1144-8.
^ Kahn SR, M'Lan CE, Lamping DL, Kurz X, Berard A, Abenhaim L. The influence of venous thromboembolism on quality of life and severity of chronic venous disease. J Thromb Haemost 2004;2:2146-51.
^ Kahn SR, Shbaklo H, Lamping DL, Holcroft CA, Shrier I, Miron MJ, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost. 2008;6:1105-12.
^ Caprini JA, Botteman MF, Stephens JM, Nadipelli V, Ewing MM, Brandt S, et al. Economic burden of long-term complications of deep vein thrombosis after total hip replacement surgery in the United States. Value Health 2003;6:59-74.
^ Bergqvist D, Jendteg S, Johansen L, Persson U, Odegaard K. Cost of long-term complications of deep venous thrombosis of the lower extremities: an analysis of a defined patient population in Sweden. Ann Intern Med 1997;126:454-7.
^ ^a ^b ^c ^d Kahn SR (2009). "How I treat postthrombotic syndrome". Blood 114 (21): 4624–31. doi:10.1182/blood-2009-07-199174. PMID 19741190.
^ Sato, D. T., Masuda, E. M. (July 1998). Journal of Vascular 28 (1): 67–74 http://www.jvascsurg.org/article/S0741-5214(98)70201-0/fulltext |url= missing title (help).
^ Kahn SR, Partsch H, Vedantham S, Prandoni P, Kearon C. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost 2009;7:879-83.
^ Shbaklo H, Holcroft CA, Kahn SR. Levels of inflammatory markers and the development of the post-thrombotic syndrome. Thromb Haemost 2009; 101:505-12.
^ Roumen-Klappe EM, Janssen MC, Van Rossum J, Holewijn S, Van Bokhoven MM, Kaasjager K, et al. Inflammation in deep vein thrombosis and the development of post-thrombotic syndrome: a prospective study. J Thromb Haemost 2009;7:582-7.
^ ^a ^b Pirard D., Bellens B., Vereecken P. The post-thrombotic syndrome - a condition to prevent. Dermatology Online Journal 14 (3): 13
^ Vedantham S. Valvular dysfunction and venous obstruction in the post-thrombotic syndrome. Thromb Res 2009; 123 Suppl 4: S62-5.
^ Tick LW, Kramer MH, Rosendaal FR, Faber WR, Doggen CJ. Risk factors for post-thrombotic syndrome in patients with a first deep venous thrombosis. J Thromb Haemost. 2008;6:2075-81.
^ Prandoni P, Lensing AWA, Cogo A, Cuppini S, Villalta S, Carta M, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996;125:1-7.
^ Shbaklo H, Kahn SR. Long-term prognosis after deep venous thrombosis. Curr Opin Hematol 2008;15:494-8.
^ Kahn SR, Kearon C, Julian JA, Mackinnon B, Kovacs MJ, Wells P, et al. Predictors of the post-thrombotic syndrome during long-term treatment of proximal deep vein thrombosis. J Thromb Haemost 2005;3:718-23.
^ ^a ^b Ageno W, Piantanida E, Dentali F, Steidl L, Mera V, Squizzato A, et al. Body mass index is associated with the development of the post-thrombotic syndrome. Thromb Haemost 2003;89:305-9.
^ van Dongen CJ, Prandoni P, Frulla M, Marchiori A, Prins MH, Hutten BA. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost 2005;3:939-42.
^ Kahn SR, Ginsberg JS. Relationship between deep venous thrombosis and the postthrombotic syndrome. Arch Intern Med 2004;164:17-26.
^ Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008;133:381S-453S.
^ ^a ^b Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:454S-545S.
^ Brandjes DP, Buller HR, Heijboer H, Huisman MV, de Rijk M, Jagt H, et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997;349:759-62.
^ Prandoni P, Lensing AW, Prins MH, Frulla M, Marchiori A, Bernardi E, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004;141:249-56.
^ Ginsberg JS, Hirsh J, Julian J, Vander LaandeVries M, Magier D, MacKinnon B, et al. Prevention and treatment of postphlebitic syndrome: results of a 3-part study. Arch Intern Med 2001;161:2105-9.
^ Aschwanden M, Jeanneret C, Koller MT, Thalhammer C, Bucher HC, Jaeger KA. Effect of prolonged treatment with compression stockings to prevent post-thrombotic sequelae: a randomized controlled trial. J Vasc Surg 2008;47:1015-21.
^ Vazquez SR, Freeman A, VanWoerkom RC, Rondina MT. Contemporary issues in the prevention and management of postthrombotic syndrome. Ann Pharmacother 2009; 43:1824-35.
^ Elman EE, Kahn SR. The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: a systematic review. Thromb Res 2006;117:609-14.
^ Prandoni P, Bernardi E, Marchiori A, et al. The long-term clinical course of acute deep vein thrombosis of the arm: prospective cohort study. BMJ 2004; 329:484-5.

UpToDate Contents

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English Journal

The Post-Thrombotic Syndrome: A 2012 Therapeutic Update.

Galanaud JP, Kahn SR.SourceDepartment of Internal Medicine, Montpellier University Hospital and EA 2992, Montpellier 1 University, Montpellier, France, jp-galanaud@chu-montpellier.fr.
Current treatment options in cardiovascular medicine.Curr Treat Options Cardiovasc Med.2013 Jan 17. [Epub ahead of print]
OPINION STATEMENT: Post-thrombotic syndrome (PTS) refers to chronic manifestations of venous insufficiency following a deep-vein thrombosis (DVT). It is a frequent, chronic, burdensome and costly disease for which therapeutic options are limited. Above all, the optimal management of PTS consists of
PMID 23325043

Presenting D-dimer and early symptom severity are independent predictors for post-thrombotic syndrome following a first deep vein thrombosis.

Roberts LN, Patel RK, Chitongo PB, Bonner L, Arya R.SourceKing's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital, London, UK.
British journal of haematology.Br J Haematol.2013 Jan 7. doi: 10.1111/bjh.12192. [Epub ahead of print]
Post-thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT). Current preventative strategies are limited to the daily wear of graduated compression stockings (GCS). The aim of this study was to evaluate early predictors of PTS. One hundred and twenty-two consecutive
PMID 23294357

Complex left profunda femoris vein to renal vein bypass for the management of progressive chronic iliofemoral occlusion.

Anaya-Ayala JE, Adams MK, Telich-Tarriba JE, Dresser KL, Ismail N, Peden EK.SourceDepartment of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, TX.
Annals of vascular surgery.Ann Vasc Surg.2013 Jan;27(1):112.e5-8. doi: 10.1016/j.avsg.2012.05.018. Epub 2012 Nov 2.
Chronic Occlusions of the inferior vena cava (IVC) and iliofemoral veins are long-term sequelae of deep venous thrombosis (DVT) that can lead to postthrombotic syndrome (PTS). Patients may present with a wide spectrum of signs and symptoms, ranging from mild discomfort and swelling to severe venous
PMID 23122979