Mechanical Treatments

Compression stockings, aside from the prevention of DVT, are effective in reducing the effects of post-thrombotic syndrome. Up to 50% of patients who have had a DVT will go on to develop post-thrombotic syndrome in the following 2 years; this is more common in the elderly and in cases of recurrent ipsilateral DVT. Current guidance is that, in addition to anticoagulation, patients are prescribed below-knee graduated compression stockings for at least 2 years, commencing one week following diagnosis.4 Trials suggest this cuts the rate of post-thrombotic syndrome by up to 50%.

Trousseau first suggested vena caval filters in 1868. Initial attempts at ligating the vena cava or limiting the diameter had high mortality rates and it wasn’t until the 1960s that the first filters were introduced. Since 1970, the Greenfield filter has been in use and reduces the risk of recurrent PE to 4%.13 Whilst not treating the underlying DVT, filters provide a management option in those patients not suitable for anti-coagulation or who have recurrent VTE despite long term warfarin therapy.4