Leg Ulcers can be Prevented After Deep Vein Thrombosis and Post-Thrombotic Syndrome

Kin Coulee Park in Medicine Hat has more than one thing to offer. (Dr. Noorali Bharwani)
Kin Coulee Park in Medicine Hat has more than one thing to offer. (Dr. Noorali Bharwani)

The title of this column suggests three interrelated health issues – deep vein thrombosis, which may lead to post-thrombotic syndrome, and in some cases the individual may end up with chronic leg ulcers.

Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, usually in the legs. Post-thrombotic syndrome is a complication of DVT and can affect 23 to 60 per cent of patients in the two years following DVT of the leg. Of those, 10 per cent may go on to develop venous ulcers.

The presentation of DVT and post-thrombotic syndrome may be quite similar. Seventy to 90 per cent of chronic leg ulcers are due to improper functioning of venous valves of the legs. It is important to remember post-thrombotic syndrome is a chronic but preventable condition. Otherwise it leads to limb pain, swelling, skin discolouration, ulceration, and rash after DVT.

An article in the Canadian Medical Association Journal (CMAJ January 7, 2014) describes the risk factors for the post-thrombotic syndrome, which include older age, obesity, male sex, iliofemoral (proximal) DVT, recurrent same side DVT, previous or primary venous insufficiency, and elevated D-dimer levels after withdrawal of anticoagulant agents.

Any individual who has had DVT should be advised regarding the long-term consequences of damaged valves in the deep veins and preventive measures. These include using compression stockings and taking low-molecular-weight heparin for at least three months after DVT is diagnosed.

Compression stockings and exercise therapy are first-line treatments for the symptoms of post-thrombotic syndrome.

A Cochrane review reported that compression stockings (30 to 40 mm Hg) used early after the diagnosis of DVT were associated with a 69 per cent reduction in the odds of post-thrombotic syndrome developing.

A systematic review also showed that long-term treatment with low-molecular weight heparin after DVT resulted in a lower incidence of post-thrombotic syndrome than treatment with anticoagulants administered orally.

The aim of management is to prevent further incidence of DVT and prevent long-term consequence in the form of chronic leg ulcers, which are not easy to treat.

An article in the American School of Laughter Yoga website titled, “Laughter helps leg ulcers heal.” quotes Dr. Andrea Nelson, University of Leeds School of Healthcare saying, “Believe it or not, having a really hearty chuckle can help too (with leg ulcers). This is because laughing gets the diaphragm moving and this plays a vital part in moving blood around the body.”

Once again, remember, more you laugh the better you get and better you feel.

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