Screening, diagnosis, and management of pediatric postthrombotic syndrome following extremity thrombosis

Pediatric postthrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT) in children, which is in turn the most common thrombotic event in childhood. Diagnosis and severity rating of PTS are based on the findings of signs and symptoms in the DVT-affected extremity. The lack of objective methods to diagnose or monitor for PTS and the consequent need to rely on symptoms can be an additional challenge in the pediatric population. Although the importance of long-term PTS monitoring in children with upper and lower extremity DVT is increasingly being recognized, the implementation of long-term follow-up in clinical practice is still suboptimal. Similarly, the management of pediatric PTS is inconsistent, in part due to the limited number of studies in this population to guide practice. The rising recognition of pediatric DVT is expected to lead to more cases of PTS in the near future, and therefore, efforts to further disseminate current knowledge on pediatric PTS among treaters are relevant. In this article, we present 2 representative cases of children with extremity DVT to address key aspects of PTS diagnosis related to patient follow-up and family counseling. This article complements the guidance developed by Postthrombotic Sequelae Working Party of the Scientific and Standardization Subcommittee on Pediatric and Neonatal Thrombosis of the International Society on Thrombosis and Haemostasis to optimize the clinical care of children with or at risk of PTS.