Challenges in The Management of Post-Thrombotic Syndrome in a Low-Resource Setting
DOI:
https://doi.org/10.54536/ajmsi.v4i2.6278Keywords:
Kenya, Persistent DVT, Post-Thrombotic Syndrome, PTS, Recurrent DVT, Villalta ScaleAbstract
Post-thrombotic syndrome (PTS) is the most common long-term complication of deep venous thrombosis (DVT) and occurs in up to 20-50% of proximal DVTs. Patients with PTS present with pain and swelling of the affected limb, edema with pruritus, skin hyperpigmentation, and venous ulcers. Risk factors for PTS include ineffective anticoagulation, obesity, and proximal DVT. The Villalta scale is validated for the diagnosis and severity scoring of PTS. The American Heart Association recommends primary and secondary prevention of PTS as the most effective management strategy since treatment of established PTS is very challenging, especially in resource-limited settings. The latter includes external compression devices, exercise, pharmacotherapy, venous ulcer management, and surgical endovascular procedures in selected patients. PTS leads to frequent hospital visits, reduced productivity, and a low quality of life. In this study, we present the diagnostic and therapeutic challenges in managing a 30-year-old woman with PTS in a rural Kenyan setting. We propose a patient-centered multidisciplinary approach to managing PTS.
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Cosmi, B., Stanek, A., Kozak, M., Wennberg, P. W., Kolluri, R., Righini, M., Poredos, P., Lichtenberg, M., Catalano, M., De Marchi, S., Farkas, K., Gresele, P., Klein-Wegel, P., Lessiani, G., Marschang, P., Pecsvarady, Z., Prior, M., Puskas, A., & Szuba, A. (2022). The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper. Front Cardiovasc Med, 9, 762443. https://doi.org/10.3389/fcvm.2022.762443
Division of Non-Communicable Diseases, M. o. H. (2018). Kenya national guidelines for cardiovascular diseases management. Ministry of Health. Retrieved 06/11/2025 from http://guidelines.health.go.ke:8000/media/Kenya_National_Guidelines_for_Cardiovascular_Diseases_Management.pdf
Galanaud, J. P., Monreal, M., & Kahn, S. R. (2018). Epidemiology of the post-thrombotic syndrome. Thromb Res, 164, 100-109. https://doi.org/10.1016/j.thromres.2017.07.026
Gautam, G., Sebastian, T., & Klok, F. A. (2020). How to Differentiate Recurrent Deep Vein Thrombosis from Postthrombotic Syndrome. Hamostaseologie, 40(3), 280-291. https://doi.org/10.1055/a-1171-0486
Guanella, R., & Kahn, S. R. (2012). Post-thrombotic syndrome: current prevention and management strategies. Expert Rev Cardiovasc Ther, 10(12), 1555-1566. https://doi.org/10.1586/erc.12.147
Kahn, S. R., Comerota, A. J., Cushman, M., Evans, N. S., Ginsberg, J. S., Goldenberg, N. A., Gupta, D. K., Prandoni, P., Vedantham, S., Walsh, M. E., & Weitz, J. I. (2014). The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies. Circulation, 130(18), 1636-1661. https://doi.org/doi:10.1161/CIR.0000000000000130
Kahn, S. R., Comerota, A. J., Cushman, M., Evans, N. S., Ginsberg, J. S., Goldenberg, N. A., Gupta, D. K., Prandoni, P., Vedantham, S., Walsh, M. E., & Weitz, J. I. (2014). The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation, 130(18), 1636-1661. https://doi.org/10.1161/cir.0000000000000130
Makedonov, I., Kahn, S. R., Abdulrehman, J., Schulman, S., Delluc, A., Gross, P., & Galanaud, J. P. (2022). Prevention of the Postthrombotic Syndrome with Anticoagulation: A Narrative Review. Thromb Haemost, 122(8), 1255-1264. https://doi.org/10.1055/a-1711-1263
Makedonov, I., Kahn, S. R., & Galanaud, J.-P. (2020). Prevention and Management of the Post-Thrombotic Syndrome. Journal of Clinical Medicine, 9(4), 923. https://www.mdpi.com/2077-0383/9/4/923
Müller, M., Wolf, F., Loewe, C., Beitzke, D., Zehetmayer, S., Gschwandtner, M. E., Willfort-Ehringer, A., Koppensteiner, R., & Schlager, O. (2023). Preprocedural imaging modalities in patients undergoing iliocaval venous recanalization and stent placement. Vasc Med, 28(4), 315-323. https://doi.org/10.1177/1358863x231161938
Vazquez, S. R., & Kahn, S. R. (2012). Advances in the diagnosis and management of postthrombotic syndrome. Best Pract Res Clin Haematol, 25(3), 391-402. https://doi.org/10.1016/j.beha.2012.06.006
Wang, J., Smeath, E., Lim, H. Y., Nandurkar, H., Kok, H. K., & Ho, P. (2023). Current challenges in the prevention and management of post-thrombotic syndrome-towards improved prevention. Int J Hematol, 118(5), 547-567. https://doi.org/10.1007/s12185-023-03651-6
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Copyright (c) 2025 Onyango C. Vonwicks, Malalu P. Collins, Auma Nicholas, Fryda C. William
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