Reply to: The efficacy and safety of antidepressants as alternative treatment of attention-deficit/hyperactivity disorder in pediatric populations.

Postthrombotic syndrome (PTS) is a chronic and debilitating condition, developing in up to 30% to 50% of patients with iliofemoral deep vein thrombosis, despite standard anticoagulation and compression therapy [,]. The condition is characterized by persistent pain, swelling, skin changes, venous claudication, and, in severe cases, ulcers []. Patients with PTS are characterized by worse quality of life (QoL) than those without PTS [,]. This may be due to functional limitations that reduce mobility and daily activity levels as well as because of symptom burden such as pain. Moreover, chronic ulcers may result in anxiety and depression, and prior thrombosis may substantially affect the emotional well-being and psychosocial functioning of patients [, , ]. It has been shown that the degree of PTS severity correlates with QoL, so improving PTS-related symptoms may lead to better functional outcomes [,]. Conservative management with compression therapy, physical rehabilitation, and pharmacologic treatment aims to alleviate symptoms, but their impact on QoL and functional outcomes has been poorly studied. Recently, the results of a randomized controlled trial showed that endovascular treatment accessory to standard PTS care can improve symptom relief and QoL compared with conservative treatment alone []. As the predictors of PTS course and QoL after endovascular treatment are unknown, it is important to follow these not only for stent patency but also focusing on functional outcomes and QoL. The Aspirin Plus Rivaroxaban Versus Rivaroxaban Alone for the Prevention of Venous Stent Thrombosis Among Patients with Postthrombotic Syndrome (ARIVA) trial demonstrated that combining aspirin with rivaroxaban did not appear to prevent stent thrombosis compared with rivaroxaban monotherapy in patients with PTS undergoing venous revascularization []. In ARIVA, functional scales and QoL were measured at predefined timepoints at baseline and over 6 months. In this post hoc analysis, we stratified patients according to the degree of PTS severity and studied the course and predictors of functional outcomes and QoL after venous revascularization.