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    Villalta Score for Post-thrombotic Syndrome (PTS)

    Stratifies severity of post-thrombotic syndrome in lower extremity DVT.
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    INSTRUCTIONS

    Use in patients with lower extremity DVT. Note: all symptoms and signs refer to the affected leg.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Use in patients with lower extremity signs and symptoms related to DVT (e.g. swelling, discoloration, ulceration) and clinical suspicion for post-thrombotic syndrome (PTS).

    • Should defer PTS diagnosis until after the acute DVT phase has passed (3–6 months).

    Venous ulceration indicates severe PTS and automatically confers a score of ≥15.

    PTS can be seen in up to half of patients with lower extremity DVT within 2 years. This score both diagnoses and grades severity of PTS.

    Symptoms
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Clinical signs
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    Present

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    • May consider conservative treatment, e.g. elastic compression stockings (ECS), for mild to moderate PTS.

    • In patients with moderate to severe PTS uncontrolled with ECS alone, may consider intermittent compression devices or pneumatic compression sleeve units.

    • For lifestyle limiting refractory and/or severe PTS, may consider endovascular treatment.

    Critical Actions

    Clinical severity, multidisciplinary evaluation, and patient preference should guide management.

    Formula

    Addition of the selected points:

    Variable

    Points

    Symptoms

    Pain

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Cramps

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Heaviness

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Paresthesia

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Pruritus

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Clinical signs

    Pretibial edema

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Skin induration

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Hyperpigmentation

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Redness

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Venous ectasia

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Pain on calf compression

    Absent

    0

    Mild

    1

    Moderate

    2

    Severe

    3

    Venous ulcer*

    Absent

    -

    Present

    Severe PTS

    *Note: presence of venous ulcer automatically confers the highest severity (severe). For scores <15 before venous ulcer is accounted for, final score is 15.

    Facts & Figures

    Interpretation:

    Villalta Score

    PTS diagnosis

    PTS severity

    0-4

    Absent

    -

    5-9

    Present

    Mild

    10-14

    Moderate

    ≥15, or presence of venous ulcer*

    Severe

    *Patients with venous ulcer after DVT and Villalta score of <15 are assigned a score of 15 according to International Society on Thrombosis and Haemostasis guidelines (Kahn 2009).

    Evidence Appraisal

    • The Villalta Score was first described in an abstract in 1994 by Villalta et al.

    • The Scientific and Standardization Committee (SSC) of the International Society on Thrombosis and Haemostasis (ISTH) in an official communication in 2009 judged that the Villalta Score was most suitable for defining the presence and severity of PTS after objectively diagnosed DVT.

    • Kahn et al in 2009 published a comprehensive review article that demonstrated good to excellent inter-rater reliability (k = 0.75; 95% CI 0.51-0.99), suggesting the Villalta Score is a reliable and valid measure of PTS in patients with previous objectively confirmed DVT.

    • Soosainathan et al investigated scoring systems for the PTS in a systematic review, which suggested that the Villalta Score combined with a venous disease-specific quality of life questionnaire should be considered the “gold standard” for the diagnosis and classification of PTS.

    • Kahn et al in the 2016 article “Guidance for the prevention and treatment of the post-thrombotic syndrome,” highlights that the Villalta Score should be used to diagnose and grade the severity of PTS in clinical studies.

    Literature

    Dr. Sabina Villalta

    About the Creator

    Sabina Villalta, MD, is the medical director of internal medicine at the Cà Foncello Hospital in Treviso, Italy. She also serves as a member of the Commission for Venous Thromboembolism and the Bioethics Committee. Dr. Villalta’s primary research is focused on venous thromboembolic pathology.

    To view Dr. Sabina Villalta's publications, visit PubMed

    Content Contributors
    • Andrew Kesselman, MD
    About the Creator
    Dr. Sabina Villalta
    Content Contributors
    • Andrew Kesselman, MD