Etiology, prevention and therapy of post-thrombotic syndrome

Posttrombotski sindrom (PTS) je kasna kronična komplikacija duboke venske tromboze (DVT). Razvija se u 20 do 30 pacijenata unutar godine dana od akutne epizode DVT-e, a najveća pojavnost je u prvih 3 do 6 mjeseci. Predstavlja skup simptoma i znakova kronične venske insuficijencije različite težine koji za posljedicu imaju značajni morbiditet i negativni utjecaj na kvalitetu života pojedinca. Zbog kronične prirode PTS ima negativni ekonomski učinak na cjelokupno zdravstvo i samog pojedinca. Troškovi zbrinjavanja se povećavaju zbog izvanbolničkog liječenja, korištenja slikovnih metoda dijagnostike, laboratorijskih analiza, hospitalizacija (ukoliko dođe do razvoja komplikacija), te primjene raznolikih farmakoloških i nefarmakoloških metoda liječenja. Cilj ovog diplomskog rada je pregled postojeće literature o posttrombotskom sindromu koji zahvaća donje ekstremitete. U uvodnom djelu dan je pregled definicije i pojavnosti, te rizičnih čimbenika za razvoj posttrombotskog sindroma. Prikazan je sažetak mogućih patofizioloških mehanizama koji se nalaze u podlozi razvoja PTS-a. Nadalje se prikazuje pristup postavljanju dijagnoze i problemi koji se javljaju zbog nepostojanje jedinstvenih kriterija, kao i nedovoljno istraženih rizičnih čimbenika i biomarkera za određivanje rizične populacije za razvoj PTS-a nakon akutne epizode DVT-e. Naglasak rada je na provođenju preventivnih mjera i multidisciplinaran pristup liječenju PTS-a. Sažeto su prikazane metode koje se koriste prema sadašnjim smjernicama American College of Chest Physicians (CHEST), kao i alternativni pristup liječenju ovisno o razini dokaza i potencijalu njihove buduće primjene. U prevenciji i liječenju ima još mjesta za napredak, stoga su prikazane prednosti i nedostaci svih metoda. U zaključku se sažeto prikazuje trenutačno stanje i ukazuje na potrebe za dodatnim istraživanjima s ciljem olakšavanja dijagnoze, klasificiranja, te prevencije i liječenja PTS.Post-thrombotic syndrome (PTS) is a chronic complication occurring at the advanced-stage of deep vein thrombosis (DVT). Namely, within a year of the acute episode of DVT, the PTS will develop in 20 to 30% of patients, with the highest occurrence in the first 3 to 6 months. PTS represents a set of symptoms indicating one form of chronic venous disorders – an array of associated conditions which generally result in significant morbidity and reduced quality of life. Due to its chronic nature, PTS also has a negative economic impact on patients. The costs of treatment have increased with the recent medical developments and trends, such as the outpatient treatment, the use of diagnostic imaging methods, laboratory analyses, the application of various pharmacological and nonpharmacological methods of treatment and, if complications show up, the cost of hospitalization. The aim of this graduate thesis is to review the existing literature on post-thrombotic syndrome affecting the lower extremities. In the introductory section, find a definition, occurrence rates, and risk factors for the development of post-thrombotic syndrome. The introduction also holds an overview of the possible pathological mechanisms found in the development and progression of the PTS. Furthermore, the introduction rises some diagnostic issues, such as the lack of symptoms unique to the condition, as well as the insufficiently-researched factors and biomarkers for determining the risk-population for developing the PTS after an acute DVT episode. Above all, the emphasis of the literature review is on texts regarding implementation of preventive measures and multidisciplinary approaches to the treatment of PTS. Thusly, summarized will be the prevention and treatment methods approved by the American College of Chest Physicians, as well as an alternative treatment approaches with a high level of proved effectiveness and a potential for clinical application. The advantages and disadvantages of all methods are shown, with a goal of detecting areas for improvement in prevention and treatment. The conclusion summarizes the status quo and points to the areas in need of further research, with an aim of contributing towards the improvements in diagnosis, classification, prevention, and treatment of PTS