The Post-Thrombotic Syndrome (PTS) refers to the long term sequelae following a venous thrombosis. It usually takes 5 or more years to develop and may range from a mild condition to one that is incapacitating. Brandjes et al developed a scoring system to grade the severity of the condition.
NOTE:
(1) This appears limited to involvement of the lower extremity.
(2) Many of the described features are those of chronic venous disease of the lower extremity (see cardiovascular chapter).
Score for Mild-to-Moderate Disease
Subjective Criteria for Mild-to-Moderate Disease |
Finding |
Points |
spontaneous pain in calf |
present |
1 |
|
absent |
0 |
spontaneous pain in thigh |
present |
1 |
|
absent |
0 |
pain in calf on standing/walking |
present |
1 |
|
absent |
0 |
pain in thigh on standing/walking |
present |
1 |
|
absent |
0 |
edema of foot/calf |
present |
1 |
|
absent |
0 |
"heaviness" of leg |
present |
1 |
|
absent |
0 |
Subjective Criteria for Mild-to-Moderate Disease |
Finding |
Points |
calf circumference |
increased by >= 1 cm |
1 |
|
increased by < 1 cm |
0 |
|
not increased |
0 |
ankle circumference |
increased by >= 1 cm |
1 |
|
increased by < 1 cm |
0 |
|
not increased |
0 |
pigmentation |
present |
1 |
|
absent |
0 |
venectasia |
present |
1 |
|
absent |
0 |
newly formed varicosis |
present |
1 |
|
absent |
0 |
phlebitis |
present |
1 |
|
absent |
0 |
score for mild-to-moderate disease =
= SUM(points for subjective and objective criteria present)
Score for Severe Disease
Subjective Criteria for Severe Disease |
Finding |
Points |
spontaneous pain AND pain on standing/walking |
present |
1 |
|
absent |
0 |
edema of calf |
present |
1 |
|
absent |
0 |
impairment in daily activities |
present |
1 |
|
absent |
0 |
Objective Criteria for Severe Disease |
Finding |
Points |
calf circumference |
increased by >= 1 cm |
1 |
|
increased by < 1 cm |
0 |
|
not increased |
0 |
pigmentation, discoloration and venectasia |
present |
1 |
|
absent |
0 |
venous ulcer |
present |
4 |
|
absent |
0 |
score for severe disease =
= SUM(points for subjective and objective criteria present)
Interpretation:
• minimum score for both scores: 0
• maximum score for mild-to-moderate disease: 12
• maximum score for maximum disease: 9
• Severe disease is present if the score for severe disease is >= 4 on 2 consecutive 3 month followup visits.
• Mild-to-moderate disease is present if the score for mild-to-moderate disease is >=3, AND 1 objective criteria is present on 2 consecutive 3 month followup visits.
• The diagnosis of post-thrombotic syndrome was not made until the patient had been followed for 6 months in order to rule out symptoms of the initial thrombotic
Specialty: Hematology Oncology, Clinical Laboratory