Postthrombotic syndrome in children

The postthrombotic syndrome (PTS) is a clinical condition of limb pain along with physical findings that range from swelling to stasis ulcers following one or more episodes of deep vein thrombosis (DVT). While venous thromboembolism has recently gained increased recognition in children, the sequelae of limb thrombi are being recognized in a substantial proportion of affected children, and with varying degrees of severity. PTS is caused by both obstructed as well as refluxed venous blood flow, with combined effects of obstruction and reflux resulting in earlier, and more extensive symptoms. PTS can be diagnosed using an evaluation tool adapted from an international adult scale. Certain risk factors predispose children to PTS including elevations in factor VIII activity and D-dimer, clot occlusiveness, clot persistence, number of venous segments involved and duration of observation following DVT. Optimal prevention and treatment have not yet been determined, although antithrombotic therapy to facilitate rapid clot resolution, elevation, compression, moderate exercise and achievement of optimal body weight are likely to improve outcome.