Effective Management Strategies For Postphlebitic Syndrome

Postphlebitic syndrome, commonly known as post-thrombotic
syndrome (PTS), is an old condition that occurs after DVT. This disease
produces discomfort, swelling and sometimes skin abnormalities in the affected
organ, resulting in severe humility and quality of life decreases. Management
of postphlebitic syndrome requires a complete treatment that ambitions to
relieve symptoms lessen additional troubles and boom the complete limb
characteristic. This article examines powerful management techniques,
consisting of non-pharmacological and pharmacological interventions.

Understanding Postphlebitic Syndrome

To properly manage syndrome, it’s important to understand
built-in pathophysiology. PTS develops when the blood clot destroys venous
valves in the affected limb, reducing venous returns and as a result of chronic
venous hypertension. This condition can cause many types of symptoms, including
mild discomfort, severe pain and ulcers. Initial identification and intervention
are important to reduce PTS’s progress and improve patient’s outcomes.

Non-Pharmacological Management Strategies

Compression Therapy

Compression therapy is the cornerstone of non-pharmacological
management for syndrome. It lowers venous hypertension, relieves symptoms and
prevents complications. Compression stockings, which provide progressive
pressure with the largest compression on ankle, are widely used. The success of
compression therapy is dependent on the proper application and compression

  • Right Compression Stockings (compression levels): Patients should receive
    compression stockings based on their needs and seriousness. The
    compression level ranges from low (15-20 mmHg) to quite high (40-50 mmHg).
    PTS usually requires high (30-40 mmHg) compression from medium (20-30
  • Proper Use: Patients should be taught the use of compression stocking. Wear
    them in the day, take off at night. Compression stocking should fit
    comfortably without any discomfort.

Elevation and Exercise

Height and exercise can help reduce the symptoms of postphlebitic
syndrome by increasing venous return and reducing edema.

  • Elevation:
    When possible, lift the affected organ above the heart level for venous
    drainage. Lifting the legs when sitting or lying down swelling and pain
  • Exercise:
    Calf-muscles exercise improves venous return and limb circulation.
    Excellent options include walking, cycling and swimming. Regular,
    low-effect exercise should be encouraged to maintain cardiovascular fitness
    and prevent venous stasis.

Weight Management

A healthy weight is necessary for patients of postphlebitic
syndrome. Excess body weight can exacerbate venous hypertension and increase
the risk of developing complications. Weight management requires healthy diet
and exercise.

  • Diet:
    A diet rich in fruits, vegetables, whole grains and lean protein can help
    maintain weight and vascular health. Salt deficiency can also decrease
  • Lifestyle
    : Encourage patients to adopt active lifestyle, stay active and
    sit or stand at least to improve symptoms and health.


Individuals with syndrome should use proper skin care as the

disorder can cause skin abnormalities and ulcers.

  • Moisturization:
    Keep the skin hydrated to protect from dryness and bursting. Patients
    should use fragrance-free light moisturizer daily.
  • Wound
    : Patients suffering from venous ulcers need proper care of the
    wound. This can include wound cleaning, dressing and topical treatment as
    per the doctor told.

Education and Support

Knowing and receiving help can help patients manage
postphlebitic syndrome.

  • Patient
    : Patients should understand their disease, treatment
    compliance and potential problems. Written materials and resources can
    help them understand.
  • Support
    : Contacting other postphlebitic syndrome patients can find
    emotional support and advice to manage the situation. Health care
    businessmen may suggest local or online support groups.

Pharmacological Management Strategies

Anticoagulant Therapy

Anticoagulant drug is necessary to treat syndrome,
especially after DVT. Anticoagulants form blood clots and reduce DVT’s

  • Medications:
    Warfarin, Direct Oral Anticoagulants (DOAC) like Rivroxaban and Epixban,
    and Anoxaparin are among the most commonly used anticoagulants such as low
    molecular weight heparin. The type of anticoagulant used is determined by
    the patient’s medical history, priorities and risks.
  • Monitoring:
    Anticoagulation level should be regularly monitored to guarantee
    therapeutic efficacy and reduce the risk of bleeding. Warfarin requires
    repeated international generalized ratio checks, while those on DOACs may
    need periodic renal function tests.

Anti-inflammatory Medications

The pathogen of postphlebitic syndrome contains
inflammation. Anti-inflammation drugs reduce the hassle and swelling of the

  • Nonsteroidal
    Anti-inflammatory Drugs
    : NSAIDs such as ibuprofen and naproxen reduce
    pain and inflammation. However, during prolonged use the side effects of
    gastrointestinal and kidney should be monitored.
  • Corticosteroids:
    Small courses of corticosteroids can treat acute inflammation in extreme
    conditions. Use them carefully under in healthcare professional.

Venoactive Medications

Venoactive medications, often known as phlebotonics, are a
class of treatment that increases venous tone and reduces symptoms of CVI, including
postphlebitic syndrome.

  • Diosmin
    and Hesperidin
    : Flavonoids increase venous tone, reduce inflammation
    and treat chronic venous inadequacy. Oral formulation can be used as supplementary
  • Horse
    Chestnut Extract
    : Another venoactive substance, horse chestnut extract
    has been used to reduce symptoms including pain and inflammation. It’s
    available on the counter in various formulations.


Diuretics may be utilized in patients with severe postphlebitic
syndrome to deal with edema. These medications help to reduce fluid retention
by increasing urine production.

  • Thiazide
    : Thiazide diuretics like hydrochlorothiazide treat mild to
    moderate edema. They reduce fluid retention and are well-tolerated.
  • Loop
    : Loop diuretics like furosemide can treat severe edema.
    Powerful drugs can cause electrolyte imbalance, so keep an eye on them.

Pain Management

Patients with postphlebitic syndrome need effective pain
management to improve life quality. Many medications and interventions can
relieve pain.

  • Analgesics:
    Acetaminophen and over-the-counter analgesics provide can provide relief
    from mild to moderate pain. Prescription analgesics may be needed for
    serious pain.
  • Topical
    : Topical lotions and ointments with chemicals like
    lidocaine or capsaicin can help in local discomfort.
  • Physical
    : Physical therapy and rehabilitation practice can increase mobility
    and reduce discomfort. Physicians can create personalized exercise plans
    based totally on the patient’s needs.

Surgical and Interventional Management Strategies

When conservative methods failed, surgical and interventional
procedures can be used to treat syndrome.

Venous Stenting

Chronic venous obstructions are treated with minimally
invasive venous stenting. Applying stent in the vein improves blood flow and
symptoms decrease.

  • Indications:
    Venous stenting is usually considered for serious a venous interruption
    which does not respond to conservative treatment.
  • Procedure:
    The stent is inserted into the vein using the catheter under local or full
    anesthesia. Most individuals can resume normal activities immediately
    after treatment.

Endovenous Ablation

The endovenous ablation seals insufficient veins. This
surgery can improve venous circulation and symptoms of postphlebitic syndrome.

  • Types:
    There are many intravenous abrasion processes, including RFA and EVLA.
    Both methods seal the veins using heat.
  • Procedure:
    The endovenous ablation under local anesthetic allows patients to return
    to normal activities in a few days.

Venous Bypass Surgery

More aggressive venous bypass surgeries are required to
reorganize blood flow around a blocked or damaged vein. Severe postphlebitic
syndrome that does not react to other treatments is considered.

  • Indications:
    Venous bypass surgery is usually reserved for individuals who have serious
    venous interruptions and have significant symptoms that are affecting
    their quality of life.
  • Procedure:
    Surgery redirects the blood flow with the graft bypass. It requires longer
    recovery than usual anesthesia and minimum invasive processes.

Monitoring and Follow-up

There are regular monitoring and follow-up important
components in the treatment of postphlebitic syndrome. Patients should be
regularly monitored for the progress of the disease, medical efficacy and
possible side effects.

Regular Assessments

The symptoms of patients of postphlebitic syndrome should be
regularly assessed for the treatment adherence of the drug and overall health.

  • Clinical
    : Patients should be examined for inflammatory limbs, skin
    abnormalities and venous ulcers by healthcare provider.
  • Imaging
    : Ultrasound and other imaging venous mechanisms can assess and
    detect new or recurring thrombi.

Patient Education and Support

Patient education and support running to ensure treatment
compliance and enhance results is important.

  • Educational
    : Educational information and resources can help patients
    understand and manage postphlebitic syndrome.
  • Support
    : Encouraging patients to join support groups or online forums
    can get emotional support and ideas of disease management.

Multidisciplinary Approach

Management of postphlebitic syndrome often requires a
comprehensive approach involving health care specialists with diverse skills.

  • Primary
    Care Physicians
    : Primary care physicians are closely monitored by
    patients of postphlebitic syndrome.
  • Vascular
    : Vascular experts can advise on venous problems and do
    traditional processes.
  • Physical
    : Physical physicians can create customized training
    programs to improve the functioning of organs and reduce discomfort.
  • Wound
    Care Specialists
    : Wound care specialists may help patients suffering
    from venous ulcers to fix.

Ask our board certified veins specialist to get rid of vein issues

If you are suffering from any vein related problem, feel free to book consultation with our board certified Dr. Nirman Tulsyan. He will check your medical reports, history and will guide step by step accordingly.  Book a consultation by visiting our website or call us at +1-973-975-4447.


Postphlebitic syndrome is chronic and can reduce the quality
of life. Management options should include non-pharmacological, pharmacological
and international methods. Compression therapy, regeneration, exercise, weight
management and skin care are important non-medicinal treatments.
Anticoagulants, anti-inflammatory drugs, venoactive drugs, diuretic and pain
management symptoms can relieve and prevent complications. In severe cases,
surgery and intervention may be needed. Patients of this syndrome need regular
monitoring, patient education, and a multidisciplinary outlook to improve the
outcomes and quality of life. Health service providers can help patients manage
their disease and live a healthy, happy life using these tips.


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