Pathogenesis and pathophysiology of the post-thrombotic syndrome: clinical implications

Anticoagulant therapy can successfully prevent pulmonary embolism and rethrombosis in most cases, but cannot affect either early morbidity or the late post-thrombotic sequelae. In carefully selected cases, early clot removal by thrombolysis or thrombectomy may be justified by improved outcome because of the significant role early and late outflow obstruction plays in determining the ultimate severity of post-thrombotic sequelae. Nevertheless, it is recognized that anticoagulant therapy will continue to be used in the majority of patients because of serious intercurrent disease, sedentary lifestyle, limited extent of thrombosis, lack of tissue loss and, unfortunately, delay in referral for treatment.