Post-Thrombotic Syndrome in Children: A Comprehensive Narrative Review

Abstract

Background and Objective

Post-thrombotic syndrome (PTS) is a chronic, often debilitating consequence of deep vein thrombosis (DVT), characterized by pain, swelling, and venous insufficiency. With paediatric venous thromboembolism (VTE) increasingly being recognized due to improved diagnostics and rising hospital interventions, understanding PTS in this population is critical. This narrative review aims to consolidate current knowledge on the incidence, risk factors, diagnosis, and management of PTS in children, while identifying clinical and research gaps unique to this age group.

Methods
A narrative literature review was conducted from January 15– April 30, 2025, incorporating data from systematic reviews, cohort studies, and guideline papers. Key sources included peer-reviewed studies focused on paediatric thrombosis and PTS, particularly drawing from databases such as PubMed and EMBASE. Articles in English were prioritized, and both retrospective and prospective data were considered.

Key Content and Findings

This review highlights that the incidence of paediatric VTE is increasing, particularly in hospitalized and high-risk groups, with PTS occurring in up to 40% of children and 20% of neonates.

Major risk factors include involvement of multiple vessels, incomplete thrombus resolution, and recurrent DVT. Protective factors identified were regular physical activity, catheter-related DVT, and provoked thrombosis. Diagnostic challenges persist due to limited validation of assessment tools, with the Manco-Johnson instrument being the only validated paediatric-specific tool. Current management emphasizes anticoagulation, physical therapy, and selective use of thrombolysis or stenting in adolescents, though evidence remains limited.

Conclusions
PTS represents a significant, underrecognized burden in paediatric patients with prior DVT. Improved risk stratification, diagnostic criteria, and individualized management protocols are urgently needed. This review calls for multicentre prospective studies to better guide clinical decisions and inform policy for PTS in children.