Subjective
Date of visit
Reason for visit (initial evaluation for suspected PTS, follow-up for diagnosed PTS)
History of present illness:
Onset and duration of symptoms following deep vein thrombosis (DVT) or pulmonary embolism (PE)
Symptoms of PTS (may include some or all of the following):
Leg swelling (unilateral or bilateral)
Pain or aching in the affected leg
Discoloration (redness or brownish skin)
Heaviness or tightness in the leg
Fatigue
Skin ulcers (in severe cases)
Severity of symptoms (impacting daily activities or quality of life)
Past medical history of DVT, PE, or other relevant conditions
Social History
Occupation and activity level (important for assessing functional limitations)
Travel history (long periods of sitting can increase risk of DVT)
Family History
Family history of blood clots
Medications
Current medications (anticoagulants, compression stockings)
Dosage and frequency of anticoagulation medication
Allergies
Allergies to medications (important for considering anticoagulant options)
Objective
Vital signs (temperature, blood pressure)
Physical exam:
Lower extremity exam:
Assess for leg swelling (measure ankle circumference for comparison)
Palpate for tenderness, skin changes (discoloration, ulcers)
Check for Homans’ sign (pain in the calf with dorsiflexion of the foot) – suggestive of DVT (limited specificity)
Assess for signs of chronic venous insufficiency (CVI) – a complication of PTS
Assessment
Suspected PTS based on clinical presentation and history of DVT/PE
Severity of PTS (based on symptoms and physical exam findings)
Acute PTS (symptoms develop within 2 years of DVT/PE)
Chronic PTS (symptoms persist beyond 2 years)
Risk factors for PTS (age, obesity, immobility)
Consideration of differential diagnoses (cellulitis, lymphedema)
Plan
Confirmation of PTS diagnosis (may not always be necessary based on clear history)
Treatment for PTS (aimed at reducing symptoms, preventing further blood clots, and improving quality of life):
Anticoagulation therapy (continued or adjusted based on individual risk factors)
Compression stockings (graduated compression to improve circulation)
Skin care to prevent ulcers (moisturizing, avoiding injuries)
Elevation of the affected leg
Exercise therapy (to improve circulation and reduce swelling)
Referral for physical therapy or occupational therapy (to address functional limitations)
Education
Explain PTS, its causes, risk factors, and potential complications (chronic venous insufficiency, skin ulcers)
Discuss the importance of medication adherence (anticoagulants) and compression stocking use.
Lifestyle modifications to reduce risk of further blood clots (exercise, maintaining a healthy weight)
Importance of skin care and early recognition of skin changes to prevent ulcers.
Follow-up
Schedule for follow-up appointments:
Monitor symptoms and response to treatment
Assess for complications
Adjust treatment plan as needed
Consider referral to a vascular specialist for complex cases or complications
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of post-thrombotic syndrome