Department of Clinical Haematology, Barts Health NHS Trust, London, UK.
Br J Hosp Med (Lond). 2023 Aug 2;84(8):1-10. doi: 10.12968/hmed.2023.0114. Epub 2023 Aug 16.
Post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension are two distinct clinical syndromes associated with adverse patient outcomes following a venous thromboembolism. Clinical manifestations of post-thrombotic syndrome include persistent pain, swelling and ultimately venous ulceration following a deep venous thrombosis. Patients experiencing chronic thromboembolic pulmonary hypertension may have symptoms ranging from exertional dyspnoea to overt right heart failure. From a physician's perspective, the most effective preventative strategy is good quality anticoagulation for prophylaxis of primary and secondary venous thromboembolism. The treatment of post-thrombotic syndrome mainly involves lifestyle modifications alongside the use of elastic compression stockings while patients with chronic thromboembolic pulmonary hypertension should be offered targeted surgical and medical treatment options available at expert centres. Further research is warranted for both conditions to determine the role of direct oral anticoagulants when used with a preventive or therapeutic intent.
血栓后综合征和慢性血栓栓塞性肺动脉高压是静脉血栓栓塞后与不良患者结局相关的两种不同的临床综合征。血栓后综合征的临床表现包括深静脉血栓形成后持续疼痛、肿胀，最终导致静脉溃疡。患有慢性血栓栓塞性肺动脉高压的患者可能会出现从运动性呼吸困难到明显右心衰竭等症状。从医生的角度来看，最有效的预防策略是使用高质量的抗凝剂预防原发性和继发性静脉血栓栓塞。血栓后综合征的治疗主要包括生活方式的改变，同时使用弹性压缩袜，而慢性血栓栓塞性肺动脉高压患者应在专家中心提供有针对性的手术和药物治疗选择。这两种疾病都需要进一步的研究，以确定直接口服抗凝剂在预防或治疗目的下的作用。
