What is a chronic Deep Vein Thrombosis (DVT)?

From the Guidelines

A chronic Deep Vein Thrombosis (DVT) is characterized by the presence of acquired environmental risk factors, such as cancer, autoimmune disorders, or chronic immobility, which increase the risk of recurrent thromboembolism. According to the American Society of Hematology 2020 guidelines for management of venous thromboembolism 1, these risk factors may fluctuate over time but often lead to a higher risk of recurrent thromboembolism if anticoagulant therapy is discontinued.

Some key points to consider in the management of chronic DVT include:

• The presence of chronic risk factors, such as autoimmune disorders (e.g., inflammatory bowel disease or antiphospholipid syndrome) or chronic immobility, which may increase the risk of recurrent thromboembolism 1
• The potential for transient risk factors (e.g., surgery) to contribute to the development of chronic DVT 1
• The importance of anticoagulant therapy in preventing recurrent thromboembolism, with a recommended duration of 3-6 months or indefinitely depending on risk factors 1
• The need for regular follow-up with a healthcare provider to monitor anticoagulation therapy and assess for complications

It is essential to note that the primary treatment of chronic DVT involves a shorter course (3-6 months) of therapeutic anticoagulation, followed by decisions regarding discontinuation or continuation of anticoagulant therapy for secondary prevention of recurrent VTE 1. The treatment plan should be individualized based on the patient's risk factors and medical history.

From the Research

Definition of Chronic Deep Vein Thrombosis (DVT)

• Chronic DVT refers to a long-standing condition where a blood clot forms in the deep veins of the body, typically in the legs [ 2 ].
• It is a frequent and potentially disabling complication that can reduce quality of life and is costly [ 2 ].

Clinical Manifestations

• Clinical manifestations of chronic DVT include symptoms and signs such as leg pain and heaviness, edema, redness, telangiectasia, new varicose veins, hyperpigmentation, skin thickening, and in severe cases, leg ulcers [ 2 ].
• The post-thrombotic syndrome (PTS) is a chronic complication of DVT that affects 20% to 50% of DVT patients [ 3 ].

Prevention and Treatment

• The best way to prevent chronic DVT is to prevent DVT with pharmacologic or mechanical thromboprophylaxis used in high-risk patients and settings [ 2 ].
• Treatment of DVT with rivaroxaban might be associated with a lower risk for PTS development compared to warfarin [ 3 ].
• Patients with established PTS may benefit from daily use of elastic compression stockings (ECS) to relieve symptoms and edema [ 2 ].
• Intermittent compression devices or pneumatic compression sleeve units can be tried in patients with moderate-to-severe PTS whose symptoms are inadequately controlled with ECS alone [ 2 ].
• A supervised exercise training program may improve PTS symptoms [ 2 ].

Risk Factors

• The principal risk factors for PTS after DVT are anatomically extensive DVT, recurrent ipsilateral DVT, persistent leg symptoms 1 month after acute DVT, obesity, and older age [ 4 ].
• By preventing the initial DVT and ipsilateral DVT recurrence, primary and secondary prophylaxes of DVT will prevent cases of PTS [ 4 ].