The direct oral anticoagulants may also be effective against the risk of post-thrombotic syndrome

The post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) of the lower limbs occurring in 40–50% of patients (1). Impaired thrombus resolution with persistent obstruction is involved in the pathogenesis of PTS, similarly to chronic thromboembolic pulmonary hypertension (CTEPH), which however develops only in a small minority of subjects after pulmonary embolism (PE)(2). Both PTS and CTEPH are associated with substantial morbidity and high healthcare expenses (2). PTS epidemiology reflects that of venous thromboembolism (VTE), which is estimated to affect 104–183 subjects per 100,000 person-years among Caucasians (3, 4), encompassing PE and DVT, with an incidence ranging from 29 to 78 and 45 to 117, per 100,000 person-years, respectively (5, 6). PTS can occur in severe forms in 10% and with the development of leg ulcers in 1–3% of patients (1). Leg ulcers