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Sun CR, Liu MY, Ni QH, Cai F, Tang F, Yu ZY, Zhang JB, Zhang L, Zhang WW, Li CM. Clinical Guidelines on Compression Therapy in Venous Diseases. Ann Vasc Surg 2024:S0890-5096(24)00451-5. [PMID: 39032593 DOI: 10.1016/j.avsg.2024.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND In recent years, compression therapy has attracted gradually increasing clinical attention in lower extremity venous diseases. However, basic concepts and clear nomenclature, standard treatment methods, and consistent product standards for pressure equipment are lacking. Therefore, developing clinical guidelines for compression therapy is essential to improving the treatment of venous diseases. METHODS Our panel generated strong (grade I), moderate (grade IIa and IIb), and weak (grade III) recommendations based on high-quality (class A), moderate-quality (class B), and low-quality (class C) evidence, using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach and the European Society of Cardiology (ESC) grading system. RESULTS The panels made 30 recommendations from current evidence, focusing on 7 fields of lower extremity venous disease (venous thromboembolism, post-thrombotic syndrome (PTS), chronic venous insufficiency (CVI), varicose veins, hemangioma and vascular malformations, lymphedema, and venous ulcers) and 18 topics. CONCLUSIONS Of the 30 recommendations made across the 18 topics, 7 were strong (grade I) and 17 were based on high-quality (class A) evidence, highlighting the need for further research of the use of compression therapy.
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Affiliation(s)
- Cong-Rui Sun
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ming-Yuan Liu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qi-Hong Ni
- Department of Vascular Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Fei Cai
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Tang
- Department of Vascular Surgery, The First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Zi-You Yu
- The Department of Plastic and Reconstructive Surgery, The Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Bin Zhang
- The Department of Cardiovascular Surgery, China-Friendship Hospital, Beijing, China
| | - Long Zhang
- Department of Vascular Surgery, Peking University Third Hospital, Beijing, China
| | | | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Khider L, Planquette B, Smadja DM, Sanchez O, Rial C, Goudot G, Messas E, Mirault T, Gendron N. Acute phase determinant of post-thrombotic syndrome: A review of the literature. Thromb Res 2024; 238:11-18. [PMID: 38643521 DOI: 10.1016/j.thromres.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is the main long-term complication of deep vein thrombosis (DVT). Several therapies are being evaluated to prevent or to treat PTS. Identifying the patients most likely to benefit from these therapies presents a significant challenge. OBJECTIVES The objective of this review was to identify risk factors for PTS during the acute phase of DVT. ELIGIBILITY CRITERIA We searched the PubMed and Cochrane databases for studies published between January 2000 and January 2021, including randomized clinical trials, meta-analyses, systematic reviews and observational studies. RESULTS Risk factors for PTS such as proximal location of DVT, obesity, chronic venous disease, history of DVT are associated with higher risk of PTS. On the initial ultrasound-Doppler, a high thrombotic burden appears to be a predictor of PTS. Among the evaluated biomarkers, some inflammatory markers such as ICAM-1, MMP-1 and MMP-8 appear to be associated with a higher risk of developing PTS. Coagulation disorders are not associated with risk of developing PTS. Role of endothelial biomarkers in predicting PTS has been poorly explored. Lastly, vitamin K antagonist was associated with a higher risk of developing PTS when compared to direct oral anticoagulants and low molecular weight heparin. CONCLUSIONS Several risk factors during the acute phase of VTE are associated with an increased risk of developing PTS. There is a high-unmet medical need to identify potential biomarkers for early detection of patients at risk of developing PTS after VTE. Inflammatory and endothelial biomarkers should be explored in larger prospective studies to identify populations that could benefit from new therapies.
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Affiliation(s)
- Lina Khider
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM, Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, 75015 Paris, France.
| | - Benjamin Planquette
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, France; F-CRIN INNOVTE, Saint-Étienne, France; Respiratory Medicine Department, Assistance Publique - Hôpitaux de Paris, 75015 Paris, France
| | - David M Smadja
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, France; F-CRIN INNOVTE, Saint-Étienne, France; Hematology Department, Assistance Publique Hôpitaux de Paris, 75015 Paris, France
| | - Olivier Sanchez
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, France; F-CRIN INNOVTE, Saint-Étienne, France; Respiratory Medicine Department, Assistance Publique - Hôpitaux de Paris, 75015 Paris, France
| | - Carla Rial
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM, Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, 75015 Paris, France
| | - Guillaume Goudot
- Université Paris Cité, PARCC, INSERM U970, Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, 75015 Paris, France
| | - Emmanuel Messas
- Université Paris Cité, PARCC, INSERM U970, Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, 75015 Paris, France
| | - Tristan Mirault
- Université Paris Cité, PARCC, INSERM U970, Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, 75015 Paris, France
| | - Nicolas Gendron
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, France; F-CRIN INNOVTE, Saint-Étienne, France; Hematology Department, Assistance Publique Hôpitaux de Paris, 75015 Paris, France
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Nielsen JD, Hermann TS, Fredskilde PCA. Graduated elastic compression stockings in the prevention of post-thrombotic syndrome: A systematic review and meta-analysis. Phlebology 2024; 39:229-237. [PMID: 38154007 DOI: 10.1177/02683555231225268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND The effect of graduated elastic compression stockings (ECS) in the prevention of post-thrombotic syndrome (PTS) has been questioned since a large randomized trial found no prophylactic effect of ECS. OBJECTIVE To assess the effect of the wearing time of ECS on the incidence of post-thrombotic syndrome (PTS) after proximal deep venous thrombosis, we performed a meta-analysis of the incidence of PTS across randomized and observational studies. METHOD PubMed, Embase and Cochrane databases were searched until 12 June 2023 for studies on the effect of ECS on PTS. References of eligible studies were also screened in order to identify other potential studies that might have been missed during the search. RESULTS Four studies comprising a total of 1467 patients met our inclusion criteria for early initiation and consistent use of ECS in patients with acute proximal DVT. ECS significantly reduced the incidence of mild-moderate PTS (OR: 0.48; 95% CI: 0.36-0.63) as well as severe PTS (OR: 0.44; 95% CI: 0.28-0.58).
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Affiliation(s)
- Jørn Dalsgaard Nielsen
- Center of Excellence for Anticoagulant Treatment, Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark
| | - Thomas Steffen Hermann
- Center of Excellence for Anticoagulant Treatment, Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark
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Thieme D, Linnemann B, Mühlberg K, Noppeney T, Kreutz M, Thieme M. Compression Therapy in Acute Deep Venous Thrombosis of the Lower Limb and for the Prevention of Post-Thrombotic Syndrome. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:188-194. [PMID: 38260965 PMCID: PMC11079798 DOI: 10.3238/arztebl.m2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND After an acute deep venous thrombosis (DVT) of the lower limb, 20% to 63% of patients develop post-thrombotic syndrome (PTS). In this review, we address the efficacy of compression therapy in the treatment of acute DVT of the lower limb, and for the prevention of PTS. METHODS 12 randomized controlled trials (RCTs) and one meta-analysis, with a total of 3751 patients, were identified in a structured literature search. RESULTS Two RCTs showed that adding compression therapy to drug treatment in the first 9 days of the acute phase of lower limb DVT led to more rapid pain relief (p<0.050) and less swelling (remaining difference in circumference, 1 cm versus 3 cm, p<0.050). As for the prevention of PTS, four RCTs showed a short-term benefit or no benefit of compression therapy. In three further RCTs, medical compression stockings (MCS) brought about a 16% to 27% absolute reduction of the frequency and severity of PTS (47% vs. 20 %, p<0.001; 40% vs. 21% (95% confidence intervals [29.9; 50.1] and [12.7; 29.5], respectively; and 58% vs. 42%, relative risk [RR] 0.73 [0,55; 0.96]). The benefit of MCS was also confirmed in a recent meta-analysis (RR 0.66 [0.44; 0.99], I2 = 88%). Thigh-length MCS were not superior to knee-length MCS for the prevention of PTS (33% vs. 36%, hazard ratio [HR] 0.93 [0.62; 1.41]). Individual, symptomoriented tailoring of the duration of treatment was not inferior to a fixed treatment duration of 24 months (29% vs. 28%; odds ratio [OR] 1.06 [0.78;1.44]). CONCLUSION Compression therapy relieves symptoms in acute DVT and lessens the frequency and severity of PTS. It is therefore recommended as standard treatment.
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Affiliation(s)
- Dorothea Thieme
- OTH Regensburg, Social and Health Care Sciences, Regensburg, Germany
| | - Birgit Linnemann
- University Medical Center of the Johannes Gutenberg-University Mainz, Department of Cardiology, Cardiology III – Angiology, Mainz, Germany
| | - Katja Mühlberg
- University Hospital Leipzig, Department for Angiology, Leipzig, Germany
| | - Thomas Noppeney
- University Hospital Regensburg, Department for Vascular Surgery, Regensburg, Germany
| | - Maria Kreutz
- OTH Regensburg, Social and Health Care Sciences, Regensburg, Germany
| | - Marcus Thieme
- Regiomed-Vascular Cente, Department of Angiology, Cardiology, Diabetology, Sonneberg, Germany
- University Hospital Jena, Department of Interna Medicine I, Angiology, Jena, Germany
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Mosti G, Wittens C, Caggiati A. Black holes in compression therapy: A quest for data. J Vasc Surg Venous Lymphat Disord 2024; 12:101733. [PMID: 38092227 DOI: 10.1016/j.jvsv.2023.101733] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE Although compression therapy (CT) is considered a crucial conservative treatment in chronic venous disease, strong evidence is missing for many clinical indications. This literature review aims to point out what strong evidence we have for CT and all the clinical scenarios where strong evidence still needs to be included. METHODS The research was conducted on MEDLINE with PubMed, Scopus and Web of Science. The time range was set between January 1980 and October 2022. Only articles in English were included. RESULTS The main problem with CT is the low scientific quality of many studies on compression. Consequently, we have robust data on the effectiveness of CT only for advanced venous insufficiency (C3-C6), deep vein thrombosis and lymphedema. We have data on the efficacy of compression for venous symptoms control and in sports recovery, but the low quality of studies cannot result in a strong recommendation. For compression in postvenous procedures, superficial venous thrombosis, thromboprophylaxis, post-thrombotic syndrome prevention and treatment, and sports performance, we have either no data or very debated data not allowing any recommendation. CONCLUSIONS We need high-level scientific studies to assess if CT can be effective or definitely ineffective in the clinical indications where we still have a paucity of or contrasting data.
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Affiliation(s)
- Giovanni Mosti
- Clinica MD Barbantini, Angiology Department, Lucca, Italy.
| | - Cees Wittens
- Department of Venous Surgery, Rotterdam, the Netherlands
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Tsiamita O, White K. Post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension: diagnosis and management. Br J Hosp Med (Lond) 2023; 84:1-10. [PMID: 37646549 DOI: 10.12968/hmed.2023.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension are two distinct clinical syndromes associated with adverse patient outcomes following a venous thromboembolism. Clinical manifestations of post-thrombotic syndrome include persistent pain, swelling and ultimately venous ulceration following a deep venous thrombosis. Patients experiencing chronic thromboembolic pulmonary hypertension may have symptoms ranging from exertional dyspnoea to overt right heart failure. From a physician's perspective, the most effective preventative strategy is good quality anticoagulation for prophylaxis of primary and secondary venous thromboembolism. The treatment of post-thrombotic syndrome mainly involves lifestyle modifications alongside the use of elastic compression stockings while patients with chronic thromboembolic pulmonary hypertension should be offered targeted surgical and medical treatment options available at expert centres. Further research is warranted for both conditions to determine the role of direct oral anticoagulants when used with a preventive or therapeutic intent.
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Affiliation(s)
- Olga Tsiamita
- Department of Clinical Haematology, Barts Health NHS Trust, London, UK
| | - Katie White
- Department of Clinical Haematology, Barts Health NHS Trust, London, UK
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Schreurs RHP, Ten Cate-Hoek AJ, Ten Cate H, Joore MA. Budget Impact of Three Improvement Targets for Compression Therapy for Patients with Deep Venous Thrombosis in The Netherlands. PHARMACOECONOMICS - OPEN 2023; 7:479-491. [PMID: 37074590 PMCID: PMC10169940 DOI: 10.1007/s41669-023-00403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Compression therapy following deep venous thrombosis in the Netherlands is suboptimal. We assessed the budget impact of targeted care improvements. METHODS We calculated the per-patient and population healthcare resource use and costs concerning 26,500 new patients each year in the Netherlands for the current pathways in region North Holland (divided into two parts: NH-A and NH-B) and region Limburg. Next, we assessed the impact of three improvement targets: optimizing initial compression therapy, early consultation of an occupational therapist, and tailored duration of elastic compression stocking therapy. Inputs were based on interview (n = 30) and survey data (n = 114), literature, and standard prices. The robustness of the results was tested by sensitivity analyses. RESULTS The current per-patient costs for a 2-year episode were €1046 (NH-A), €947 (NH-B), and €1256 (Limburg). The improvements led to direct savings for region Limburg (€4.7 million). Population costs increased in the first year for NH-A (+ €3.5 million) and NH-B (+ €6.4 million), and decreased in the second and third year resulting in a cost reduction for NH-A (- €2.2 million) but not for NH-B (+ €0.6 million). Workload for occupational therapists and internists in North Holland increased, and workload for home care nurses decreased in all regions. CONCLUSIONS This study provides a detailed insight into current costs and healthcare resource use associated with compression therapy and the potential impact of implementing three improvement targets. We showed that the improvements resulted in considerable cost savings within 3 years after implementation for region NH-A and Limburg.
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Affiliation(s)
- Rachel H P Schreurs
- Thrombosis Expert Centre Maastricht and Laboratory for Clinical Thrombosis and Haemostasis, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Arina J Ten Cate-Hoek
- Thrombosis Expert Centre Maastricht and Laboratory for Clinical Thrombosis and Haemostasis, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Hugo Ten Cate
- Thrombosis Expert Centre Maastricht and Laboratory for Clinical Thrombosis and Haemostasis, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Meng J, Liu W, Wu Y, Xiao Y, Tang H, Gao S. Is it necessary to wear compression stockings and how long should they be worn for preventing post thrombotic syndrome? A meta-analysis of randomized controlled trials. Thromb Res 2023; 225:79-86. [PMID: 37030189 DOI: 10.1016/j.thromres.2023.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/13/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Post thrombotic syndrome (PTS) is a serious complication of deep venous thrombosis (DVT). There were always debates on the efficacy of elastic compression stockings (ECS) in prevention for post thrombotic syndrome. OBJECTIVE To assess effects of elastic compression stockings and ECS's wearing time on post thrombotic syndrome after diagnosis of deep venous thrombosis. METHODS PubMed, Cochrane Library, Embase, Web of Science were last searched on 23 November 2022 for studies assessing effects of elastic compression stockings or theirs wearing time on post thrombotic syndrome after diagnosis of deep venous thrombosis. RESULTS 9 randomized controlled trials were included. Wearing elastic compression stockings was associated with a statistically reduction in the overall post thrombotic syndrome rate (RR 0.73, 95 % CI 0.53 to 1.00; P = 0.05; I2 = 82 %). No significant difference in severe post thrombotic syndrome rate, recurrent deep venous thrombosis rate, and death rate was seen whether wearing elastic compression stockings or not. The pooled effect of studies comparing different wearing time of elastic compression stockings showed no significant difference in post thrombotic syndrome rate, severe and moderate post thrombotic syndrome rate, recurrent deep venous thrombosis syndrome rate and death rate. CONCLUSIONS Wearing ECS can reduce the risk of developing PTS after DVT and a wearing time of less than or equal to 1 year is comparable to 2 years wearing. The results support ECS's role as a foundation therapy for preventing PTS.
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Berther D, Jeanneret-Gris CR. Comparison of the standardized Valsalva manoeuvre versus the cuff deflation method to elicit venous reflux. VASA 2022; 51:305-313. [DOI: 10.1024/0301-1526/a001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: Two standardized methods to detect venous reflux, the Valsalva manoeuvre (VM) and the cuff deflation method (CM) are compared. Patients and methods: We included 72 patients with varicose veins (VV) and 106 patients with deep vein thrombosis (DVT). The proximal leg veins were examined. A survey was sent to the members of the Union of Vascular Societies to assess, which methods are used in the clinical practice. Results: In the VV-group the correlation coefficient (VM vs CM) for the reflux time (RT) amounted to 0.44 (p<0.0001) for the common femoral vein (CFV) and 0.4 for the femoral vein (FV) (p=0.0003). The sensitivity of the two tests in the VV group amounted to 87.5% for both methods in the CFV (p=0.4). The sensitivity for the FV amounted to 87.5% for the VM and 71.4% for the CM (p=0.4). In the DVT – group the correlation coefficient (VM vs CM) for RT amounted to 0.62 for the CFV (p<0.0001) and 0.77 for the FV (p<0.0001), as well as to 0.6 for the great saphenous vein (GSV) (p<0.0001). The sensitivity of the two tests amounted to 50.0% for the VM and 42.9% for the CM in the CFV (p=0.5). The sensitivity, if reflux was measured in the FV, amounted to 42.9% for the VM and 50.0% for the CM (p=0.5). 87.3% of the doctors who answered the survey use a non-standardized reflux measurement method. Conclusions: Both methods of reflux measurement (VM, CM) are comparable. Further studies have to address the issue, whether non standardized methods are as accurate as the standardized manoeuvres.
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Affiliation(s)
- Dario Berther
- Angiology Department, University Clinic of Internal Medicine, University of Basel, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Christina R. Jeanneret-Gris
- Angiology Department, University Clinic of Internal Medicine, University of Basel, Kantonsspital Baselland, Bruderholz, Switzerland
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Yang X, Zhang X, Yin M, Wang R, Lu X, Ye K. Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal. J Vasc Surg Venous Lymphat Disord 2021; 10:293-299. [PMID: 34358673 DOI: 10.1016/j.jvsv.2021.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of elastic compression stockings(ECS) in prevention of post-thrombotic syndrome(PTS) in patients suffering from proximal deep venous thrombosis (DVT) who did not receive thrombus removal procedures. METHODS In this randomized trial, patients with Iliofemoral venous thrombosis (IFDVT)and Femoral-popliteal venous thrombosis (Fem-pop DVT) who had not undergone thrombus removal procedures were screened at a single medical institution between December 2016 and June 2018. These patients were randomly assigned as an ECS group(wear ECS) and control group(not wear ECS). The primary endpoint was the incidence of PTS based on Villata scale at 24 months. The secondary endpoints included patients' quality of life and symptom severity based on the VEINES-QoL/Sym questionnaire. Recurrent DVT in the same limb, compliance with ECS use and other adverse events were also recorded. Logistic regression analysis was also performed to determine risk factors of PTS. RESULTS Two hundred and thirty two patients were included in this study.One hundred and thirteen patients were in the ECS group and 119 in the control group. The incidence of PTS was 42.0% in the ECS group and 57.8% in the control group at 24 months (risk ratio[RR] = 0.726, 95% CI 0.547-0.964; P = .024). VEINES-QoL score was 63.7 ± 4.6 in the ECS group, which was higher than in the control group(60.6 ± 6.9), P < .001. Moreover, VEINES-Sym scores revealed that patients in the ECS group reported better symptom relief than those in the control group (45.8 ± 5.1 vs. 43.8 ± 6.1, P = .014). According to Logistic regression analysis of the entire cohort, IFDVT was a risk factor for PTS (RR=2.253,95% CI 1.136-4.468)and high compliance with use of ECS was protect factor(RR=0.516, 95%CI 0.277-0.961). CONCLUSIONS The results suggest that ECS can prevent PTS in patients with IFDVT and Fem-pop DVT who do not receive thrombus removal procedures.
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Affiliation(s)
- Xinrui Yang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine; Vascular Center of Shanghai JiaoTong University, Shanghai 200011, China
| | - Xing Zhang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine; Vascular Center of Shanghai JiaoTong University, Shanghai 200011, China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine; Vascular Center of Shanghai JiaoTong University, Shanghai 200011, China
| | - Ruihua Wang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine; Vascular Center of Shanghai JiaoTong University, Shanghai 200011, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine; Vascular Center of Shanghai JiaoTong University, Shanghai 200011, China
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine; Vascular Center of Shanghai JiaoTong University, Shanghai 200011, China.
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[Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC) : S2k guideline of the German Phlebology Society (DGP) in cooperation with the following professional associations: DDG, DGA, DGG, GDL, DGL, BVP. German version]. Hautarzt 2021; 72:137-152. [PMID: 33301064 DOI: 10.1007/s00105-020-04734-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rabe E, Földi E, Gerlach H, Jünger M, Lulay G, Miller A, Protz K, Reich-Schupke S, Schwarz T, Stücker M, Valesky E, Pannier F. Medical compression therapy of the extremities with medical compression stockings (MCS), phlebological compression bandages (PCB), and medical adaptive compression systems (MAC) : S2k guideline of the German Phlebology Society (DGP) in cooperation with the following professional associations: DDG, DGA, DGG, GDL, DGL, BVP. Hautarzt 2021; 72:37-50. [PMID: 33386416 PMCID: PMC8692288 DOI: 10.1007/s00105-020-04706-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Affiliation(s)
- E Rabe
- Emeritus Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Germany.
| | - E Földi
- Földiklinik, Rösslehofweg 2-6, 79856, Hinterzarten, Germany
| | - H Gerlach
- , Zehntstr. 25, 68519, Viernheim, Germany
| | - M Jünger
- Klinik und Poliklinik f. Hautkrankheiten, Universitätsmedizin, Ferdinand Sauerbruchstraße, 17475, Greifswald, Germany
| | - G Lulay
- Klinik für Gefäß- u. Endovaskularchirurgie, Phlebologie-Lymphologie, Frankenburgstr. 31, 48431, Rheine, Germany
| | - A Miller
- Dermatologische Praxis, Wilmersdorfer Str. 62, 10627, Berlin, Germany
| | - K Protz
- Wundforschung, Universitätsklinikum Hamburg-Eppendorf, Bachstr. 75, 22083, Hamburg, Germany
| | - S Reich-Schupke
- Privatpraxis für Haut- und Gefäßmedizin, Wundtherapie, Hertener Str. 27, 45657, Recklinghausen, Germany
| | - T Schwarz
- Praxis für Gefäßmedizin, Konrad Goldmann Str. 5b, 79100, Freiburg, Germany
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - F Pannier
- Praxis für Dermatologie & Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany
- Dermatologische Universitätsklinik Köln, Cologne, Germany
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Gwozdz AM, Black SA, Hunt BJ, Lim CS. Post-thrombotic Syndrome: Preventative and Risk Reduction Strategies Following Deep Vein Thrombosis. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2020.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Venous disease is common in the general population, with chronic venous disorders affecting 50–85% of the western population and consuming 2–3% of healthcare funding. It, therefore, represents a significant socioeconomic, physical and psychological burden. Acute deep vein thrombosis, although a well-recognised cause of death through pulmonary embolism, can more commonly lead to post-thrombotic syndrome (PTS). This article summarises the pathophysiology and risk factor profile of PTS, and highlights various strategies that may reduce the risk of PTS, and the endovenous management of iliofemoral deep vein thrombosis. The authors summarise the advances in PTS risk reduction strategies and present the latest evidence for discussion.
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Affiliation(s)
- Adam M Gwozdz
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, Guy’s and St Thomas’ NHS Trust, King’s College London, London, UK
| | - Stephen A Black
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, Guy’s and St Thomas’ NHS Trust, King’s College London, London, UK
| | - Beverley J Hunt
- Thrombosis and Haemostasis Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Chung S Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
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14
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Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, Ten Cate-Hoek AJ, Elalamy I, Enzmann FK, Geroulakos G, Gottsäter A, Hunt BJ, Mansilha A, Nicolaides AN, Sandset PM, Stansby G, Esvs Guidelines Committee, de Borst GJ, Bastos Gonçalves F, Chakfé N, Hinchliffe R, Kolh P, Koncar I, Lindholt JS, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, De Maeseneer MG, Comerota AJ, Gloviczki P, Kruip MJHA, Monreal M, Prandoni P, Vega de Ceniga M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg 2020; 61:9-82. [PMID: 33334670 DOI: 10.1016/j.ejvs.2020.09.023] [Citation(s) in RCA: 304] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Ning J, Ma W, Fish J, Trihn F, Lurie F. Biases of Villalta scale in classifying post-thrombotic syndrome in patients with pre-existing chronic venous disease. J Vasc Surg Venous Lymphat Disord 2020; 8:1025-1030. [DOI: 10.1016/j.jvsv.2020.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
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Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, Hutten BA, Jaff MR, Manja V, Schulman S, Thurston C, Vedantham S, Verhamme P, Witt DM, D Florez I, Izcovich A, Nieuwlaat R, Ross S, J Schünemann H, Wiercioch W, Zhang Y, Zhang Y. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4:4693-4738. [PMID: 33007077 PMCID: PMC7556153 DOI: 10.1182/bloodadvances.2020001830] [Citation(s) in RCA: 637] [Impact Index Per Article: 159.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually. OBJECTIVE These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE. METHODS ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events. CONCLUSIONS Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE.
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Affiliation(s)
- Thomas L Ortel
- Division of Hematology, Department of Medicine, Duke University, Durham NC
| | | | - Walter Ageno
- Department of Medicine and Surgery, University of Insurbria, Varese, Italy
| | - Rebecca Beyth
- Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Nathan P Clark
- Clinical Pharmacy Anticoagulation Service, Kaiser Permanente, Aurora, CO
| | - Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Barbara A Hutten
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Veena Manja
- University of California Davis, Sacramento, CA
- Veterans Affairs Northern California Health Care System, Mather, CA
| | - Sam Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Suresh Vedantham
- Division of Diagnostic Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Peter Verhamme
- KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Daniel M Witt
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT
| | - Ivan D Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ariel Izcovich
- Internal Medicine Department, German Hospital, Buenos Aires, Argentina; and
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Stephanie Ross
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuqing Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Ouko I, Obimbo MM, Kigera J, Ogeng'o JA. Valve distribution of the popliteal vein: A structural basis for deep venous thrombosis? Phlebology 2020; 35:799-804. [PMID: 32660371 DOI: 10.1177/0268355520940453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the relationship between number and distribution of valves. METHODS Sixty-six popliteal vein specimens were used for the study after routine dissection at the Department of Human Anatomy, University of Nairobi. The extents of the popliteal vein were identified at the adductor hiatus and soleal arch, cut at these points and then longitudinally sliced open. The number and distribution of valves were then recorded. Data were presented using photomacrographs and tables. RESULTS The median number of valves was 1 (mean 0.8; range 0-2), with the lower part of the popliteal vein as the most consistent valve position. Most striking was the valve absence noted in 27 (41%) of the veins. CONCLUSION These findings suggest that a significant proportion of popliteal veins do not have valves thus providing a credible structural link that may predispose the popliteal vein to deep venous thrombosis in the study population.
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Affiliation(s)
- Innocent Ouko
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Moses M Obimbo
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - James Kigera
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Julius A Ogeng'o
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
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Rognoni C, Lugli M, Maleti O, Tarricone R. Venous stenting for patients with outflow obstruction and leg ulcers: cost–effectiveness and budget impact analyses. J Comp Eff Res 2020; 9:705-720. [DOI: 10.2217/cer-2020-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: To perform cost–effectiveness analysis (CEA) and budget impact analysis (BIA) comparing stenting to standard medical treatment (SMT) for the management of deep venous outflow obstruction and leg ulcers from the Italian Healthcare Service perspective. Materials & methods: A Markov model was developed to project costs and quality-adjusted life-years (QALYs) over 3 years, based on data from literature combined with real-world data. Moreover, a BIA was performed comparing the current scenario (100% SMT) with increasing utilization rates of stenting over SMT from 0.5 to 5%, in the next 5 years. Results: Stenting is a cost-effective (incremental cost-utility ratio €12,388/QALY) or dominant option versus SMT, according to in-patient or day-hospital settings, respectively. Increasing use of stenting over SMT, in the next 5 years, is expected to yield additional costs of 39.5 million Euros (in-patient) or savings of 5.1 million Euros (day-hospital). Conclusion: Stenting is a cost-effective option compared with SMT for patients with deep vein occlusion and ulceration in Italy.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan 20136, Italy
| | - Marzia Lugli
- National Reference Training Center in Phlebology (NRTCP), Vascular Surgery – Cardiovascular Deptartment, Hesperia Hospital, Modena 41125, Italy
| | - Oscar Maleti
- National Reference Training Center in Phlebology (NRTCP), Vascular Surgery – Cardiovascular Deptartment, Hesperia Hospital, Modena 41125, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan 20136, Italy
- Department of Social and Political Sciences, Bocconi University, Milan 20136, Italy
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19
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Prevention and Management of the Post-Thrombotic Syndrome. J Clin Med 2020; 9:jcm9040923. [PMID: 32230912 PMCID: PMC7230648 DOI: 10.3390/jcm9040923] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022] Open
Abstract
The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency secondary to prior deep vein thrombosis (DVT). It affects up to 50% of patients after proximal DVT. There is no effective treatment of established PTS and its management lies in its prevention after DVT. Optimal anticoagulation is key for PTS prevention. Among anticoagulants, low-molecular-weight heparins have anti-inflammatory properties, and have a particularly attractive profile. Elastic compression stockings (ECS) may be helpful for treating acute DVT symptoms but their benefits for PTS prevention are debated. Catheter-directed techniques reduce acute DVT symptoms and might reduce the risk of moderate-severe PTS in the long term in patients with ilio-femoral DVT at low risk of bleeding. Statins may decrease the risk of PTS, but current evidence is lacking. Treatment of PTS is based on the use of ECS and lifestyle measures such as leg elevation, weight loss and exercise. Venoactive medications may be helpful and research is ongoing. Interventional techniques to treat PTS should be reserved for highly selected patients with chronic iliac obstruction or greater saphenous vein reflux, but have not yet been assessed by robust clinical trials.
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20
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Salahuddin T, Armstrong EJ. Intervention for Iliofemoral Deep Vein Thrombosis and May-Thurner Syndrome. Interv Cardiol Clin 2020; 9:243-254. [PMID: 32147124 DOI: 10.1016/j.iccl.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
May-Thurner syndrome, also known as iliac vein compression syndrome, may cause symptoms of venous hypertension and is a predisposing factor for the development of iliofemoral deep vein thrombosis (DVT). Iliofemoral DVT is associated with high rates of development of postthrombotic syndrome, a potentially debilitating condition associated with development of symptoms related to venous outflow obstruction and resulting in reduced quality of life. In this Clinics article, we review procedural intervention with catheter-directed thrombolysis and stenting for iliofemoral DVT and iliac vein compression.
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Affiliation(s)
- Taufiq Salahuddin
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA
| | - Ehrin J Armstrong
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA; Interventional Cardiology, Vascular Laboratory, Rocky Mountain Regional VA, Division of Cardiology, University of Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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21
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Dawson AJ, Akaberi A, Galanaud J, Morrison DR, Kahn SR. Patient-reported reasons for and predictors of noncompliance with compression stockings in a randomized trial of stockings to prevent postthrombotic syndrome. Res Pract Thromb Haemost 2020; 4:269-277. [PMID: 32110758 PMCID: PMC7040536 DOI: 10.1002/rth2.12296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/28/2019] [Accepted: 11/19/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Elastic compression stockings (ECSs) are used to treat symptoms of venous insufficiency. However, lack of patient compliance can limit their effectiveness. In a secondary analysis of the SOX Trial, a randomized trial of active vs. placebo ECSs worn for 2 years to prevent postthrombotic syndrome after deep vein thrombosis, we aimed to describe patient-reported reasons for nondaily use of ECS and to identify predictors of noncompliance during follow-up. METHODS At each follow-up visit of the SOX Trial, patients were asked how many days per week they wore study stockings, and if not worn daily, to specify the reason(s). Reasons for nondaily use of ECSs were tabulated. Multiple logistic regression modeling was used to identify predictors of stocking noncompliance during follow-up (defined as use <3 days per week). RESULTS Among the 776 patients who attended at least 1 follow-up visit, daily use of stockings at each visit was similar in the active and placebo ECS groups. Reasons for nondaily use of stockings was most frequently related to aversive aspects of stockings (~three-fourths of patients) and less often related to patient behaviors (~one-fourth of patients). In multivariate analyses, behavior-related and aversive aspect-related reasons for nondaily use of ECSs at the 1-month visit were significant predictors of noncompliance during follow-up (odds ratio [OR] = 4.41 [95% confidence interval, 2.12-9.17] and OR = 3.99 [2.62-6.08], respectively). CONCLUSIONS Aversive aspects of ECSs and patient behaviors are important reasons for noncompliance. Improving the appeal and tolerability of ECS and education directed at modifying patient behaviors may improve compliance.
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Affiliation(s)
| | - Arash Akaberi
- Center for Clinical EpidemiologyLady Davis InstituteMontrealQCCanada
| | - Jean‐Philippe Galanaud
- Department of MedicineSunnybrook Health Sciences Centre and University of TorontoTorontoONCanada
| | - David R. Morrison
- Center for Clinical EpidemiologyLady Davis InstituteMontrealQCCanada
| | - Susan R. Kahn
- Center for Clinical EpidemiologyLady Davis InstituteMontrealQCCanada
- Department of MedicineMcGill UniversityMontrealQCCanada
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Ferreira T, Huber SC, de Moraes Martinelli B, Junior AL, Menezes FH, Orsi FA, Bittar LF, de Oliveira LFG, Sodre LR, Mello TT, Rielli G, Colella MP, de Paula EV, Yamaguti-Hayakawa GG, Montalvão S, Annichino-Bizzacchi JM. Low prevalence of Post-thrombotic syndrome in patients treated with rivaroxaban. Vascul Pharmacol 2020; 124:106608. [DOI: 10.1016/j.vph.2019.106608] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022]
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Couturaud F, Fischer AM, Laporte S, Sanchez O. [What are the options for the initial anticoagulant treatment of a PE and a proximal DVT?]. Rev Mal Respir 2019; 38 Suppl 1:e41-e52. [PMID: 31699457 DOI: 10.1016/j.rmr.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F Couturaud
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine interne et pneumologie, EA3878-GETBO, CIC Inserm1412, université de Bretagne occidentale, centre hospitalo-universitaire de Brest, 29200 Brest, France
| | - A-M Fischer
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Service d'hématologie biologique, hôpital européen Georges-Pompidou, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - S Laporte
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Inserm, unité de recherche clinique, SAINBOIS U1059 équipe DVH, hôpital Nord, université Jean-Monnet, université de Lyon, innovation, pharmacologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Université de Paris, Service de pneumologie et soins intensifs, AH-HP, Hôpital Européen Georges Pompidou, 75015 Paris, France; Innovations Thérapeutiques en Hémostase, INSERM UMRS 1140, 75006 Paris, France.
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24
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[What is the place of compressive treatment?]. Rev Mal Respir 2019; 38 Suppl 1:e131-e137. [PMID: 31623891 DOI: 10.1016/j.rmr.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Avila M, Montoya M, Lumia C, Marson A, Brandão L, Tomlinson G. Compression stockings to prevent post-thrombotic syndrome in adults, a Bayesian meta-analysis. Thromb Res 2019; 182:20-26. [DOI: 10.1016/j.thromres.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/26/2019] [Accepted: 08/10/2019] [Indexed: 02/07/2023]
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Azirar S, Appelen D, Prins MH, Neumann MHAM, de Feiter ANP, Kolbach DN. Compression therapy for treating post-thrombotic syndrome. Cochrane Database Syst Rev 2019; 9:CD004177. [PMID: 31531971 PMCID: PMC6749555 DOI: 10.1002/14651858.cd004177.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and compression therapy. There have been limited studies regarding the effectiveness of compression therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of compression therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. OBJECTIVES To assess the effectiveness of compression therapy for treatment of post-thrombotic syndrome, including elastic compression stockings and mechanical devices compared with no intervention, placebo and with each other. SEARCH METHODS For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. SELECTION CRITERIA We included trials that evaluated compression therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. DATA COLLECTION AND ANALYSIS One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. MAIN RESULTS We identified four trials, with 116 participants, investigating the effectiveness of compression therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical compression devices.None of the studies evaluated patient satisfaction. AUTHORS' CONCLUSIONS There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to compression device use owing to small studies of short duration. High-certainty evidence to support the use of compression therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.
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Affiliation(s)
- Sara Azirar
- Huidcentrum LimburgDepartment of DermatologyMaastrichtNetherlands
| | - Diebrecht Appelen
- Radboud University Nijmegen Medical CenterDepartment of DermatologyNijmegenNetherlands
| | - Martin H Prins
- CAPHRI Research School, Maastricht UniversityDepartment of EpidemiologyMaastrichtNetherlands6200 MD
| | - Martino HAM Neumann
- Erasmus Medical CenterDepartment of DermatologyPO Box 2040RotterdamNetherlands3000 CA
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27
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Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. [Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV)]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:e1-e47. [PMID: 30770089 DOI: 10.1016/j.jdmv.2018.12.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38043 Grenoble, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, Hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, Hôpital Nord, CHU St-Étienne, 42, avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue de la Maison Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, 38043 Grenoble, France.
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Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV). JOURNAL DE MEDECINE VASCULAIRE 2019; 44:28-70. [PMID: 30770082 DOI: 10.1016/j.jdmv.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens Picardie, avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38700 La Tronche, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, hôpital Nord, CHU St.-Étienne, 42, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St.-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 1328, avenue Maison-Blanche, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38043 Grenoble, France.
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Treatments to prevent primary venous ulceration after deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2019; 7:260-271.e1. [PMID: 30660582 DOI: 10.1016/j.jvsv.2018.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 12/02/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to assess whether compression stockings or other interventions reduce the incidence of venous ulceration after acute deep venous thrombosis. METHODS We searched PubMed and Embase for randomized controlled trials (RCTs), restricted to English, Spanish, and Hebrew, related to post-thrombotic syndrome and venous ulceration in participants with confirmed deep venous thrombosis. Our primary statistical assessment was the Peto odds ratio (OR). RESULTS Our search generated 23 RCTs meeting inclusion and exclusion criteria, summing 6162 patients and 146 ulcerative events. Trials were categorized into compression, low-molecular-weight heparin (LMWH), procedural thrombolysis, medical thrombolysis, or miscellaneous. Six compression trials were identified, of which five were included in meta-analysis. Compression compared with placebo did not reduce venous ulceration (OR, 0.915; 95% confidence interval [CI], 0.475-1.765), and long-term compression was not superior to short-term compression (OR, 1.36; 95% CI, 0.014-1.31). Four LMWH trials were identified but were not subjected to meta-analysis because of intertrial heterogeneity. One trial, comparing extended tinzaparin with warfarin, demonstrated eight ulcers in the warfarin group and one ulcer in the LMWH group (relative risk, 0.125; P < .05). Three procedural thrombolysis trials were pooled into meta-analysis; fewer ulcerative events occurred in procedural thrombolysis patients, but the effect was not significant (OR, 0.677; 95% CI, 0.338-1.358). Eight medical thrombolysis trials were identified. Pooled analysis of five trials demonstrated a protective effect on ulceration in streptokinase patients vs standard heparinization (OR, 0.125; 95% CI, 0.021-0.739). However, these trials were of poor-quality study design, had small sample size, and had poor overall outcomes. Miscellaneous studies included a trial of hidrosmina, a vasoactive flavonoid, and a trial comparing 6-month warfarin treatment with 6 weeks; neither trial had significant outcomes. Intertrial heterogeneity was not adequately assessed with the I2 value as venous ulceration is a rare event; the Grading of Recommendations Assessment, Development, and Evaluation evidence for most trials was very low, with the exception of procedural thrombolysis trials, for which it was low. CONCLUSIONS We found insufficient evidence to assess whether compression or other interventions protect against venous ulceration. To develop guidelines for treatment decisions related to prevention of venous ulceration, high-powered RCTs investigating venous leg ulcers as a primary outcome are required.
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Labropoulos N. Elastic compression therapy to prevent post-thrombotic syndrome. Lancet Haematol 2018; 5:e494-e495. [PMID: 30314711 DOI: 10.1016/s2352-3026(18)30159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 06/08/2023]
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Amin EE, ten Cate-Hoek AJ, Bouman AC, Meijer K, Tick L, Middeldorp S, Mostard G, ten Wolde M, van den Heiligenberg S, van Wissen S, van de Poel M, Villalta S, Serné E, Otten HM, Klappe E, Prandoni P, Prins MH, ten Cate H, Joore MA. Individually shortened duration versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome: a cost-effectiveness analysis. LANCET HAEMATOLOGY 2018; 5:e512-e519. [DOI: 10.1016/s2352-3026(18)30151-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 01/26/2023]
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Nishimoto Y, Yamashita Y, Morimoto T, Saga S, Amano H, Takase T, Hiramori S, Kim K, Oi M, Akao M, Kobayashi Y, Toyofuku M, Izumi T, Tada T, Chen PM, Murata K, Tsuyuki Y, Sasa T, Sakamoto J, Kinoshita M, Togi K, Mabuchi H, Takabayashi K, Shiomi H, Kato T, Makiyama T, Ono K, Sato Y, Kimura T. Risk factors for post-thrombotic syndrome in patients with deep vein thrombosis: from the COMMAND VTE registry. Heart Vessels 2018; 34:669-677. [DOI: 10.1007/s00380-018-1277-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/28/2018] [Indexed: 11/30/2022]
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Present and future options for treatment of infrainguinal deep vein disease. J Vasc Surg Venous Lymphat Disord 2018; 6:664-671. [PMID: 30007531 DOI: 10.1016/j.jvsv.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/13/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Management of chronic deep vein disease focuses on the alleviation of reflux and obstruction. For the suprainguinal veins, the main underlying pathologic process is obstruction, which has been recognized as a significant contributor to chronic venous insufficiency. This is currently being addressed with venous stenting and the development of dedicated stents designed for this segment of the venous system. Treatment of the femoropopliteal vein (FPV) is far more challenging because of the idiosyncratic anatomy, the hemodynamic physiology, and the technical aspects of size mismatch and valve flow dynamics in managing deep venous reflux. This review article discusses traditional and emerging technologies to treat infrainguinal disease. METHODS Previous and current articles addressing this issue were reviewed. Emphasis was placed on emerging techniques and technologies. RESULTS Significant bench work, in vitro and in vivo studies, have been conducted over the last 40 years addressing the issue of infrainguinal reflux and obstruction. Historically, open procedures to address FPV reflux and obstruction have had variable success in a few centers around the world. The significant increase of emerging endovascular therapies may allow more appropriate, reproducible, widespread treatment of infrainguinal deep venous disease. CONCLUSIONS Adequate and durable therapies for infrainguinal venous disease represent one of the greatest challenges for a vein specialist. Recently, a cluster of interest and techniques/technologies have been developed. The endovascular management of arterial disease is mature. The endovenous management of infrainguinal disease is on the cusp of meaningful innovation. The purpose of this evidence summary is to describe the options for the management of chronic FPV disease, with emphasis on emerging technologies and techniques.
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Rabe E, Partsch H, Hafner J, Lattimer C, Mosti G, Neumann M, Urbanek T, Huebner M, Gaillard S, Carpentier P. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology 2018; 33:163-184. [PMID: 28549402 PMCID: PMC5846867 DOI: 10.1177/0268355516689631] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective Medical compression stockings are a standard, non-invasive treatment option for all venous and lymphatic diseases. The aim of this consensus document is to provide up-to-date recommendations and evidence grading on the indications for treatment, based on evidence accumulated during the past decade, under the auspices of the International Compression Club. Methods A systematic literature review was conducted and, using PRISMA guidelines, 51 relevant publications were selected for an evidence-based analysis of an initial 2407 unrefined results. Key search terms included: 'acute', CEAP', 'chronic', 'compression stockings', 'compression therapy', 'lymph', 'lymphatic disease', 'vein' and 'venous disease'. Evidence extracted from the publications was graded initially by the panel members individually and then refined at the consensus meeting. Results Based on the current evidence, 25 recommendations for chronic and acute venous disorders were made. Of these, 24 recommendations were graded as: Grade 1A (n = 4), 1B (n = 13), 1C (n = 2), 2B (n = 4) and 2C (n = 1). The panel members found moderately robust evidence for medical compression stockings in patients with venous symptoms and prevention and treatment of venous oedema. Robust evidence was found for prevention and treatment of venous leg ulcers. Recommendations for stocking-use after great saphenous vein interventions were limited to the first post-interventional week. No randomised clinical trials are available that document a prophylactic effect of medical compression stockings on the progression of chronic venous disease (CVD). In acute deep vein thrombosis, immediate compression is recommended to reduce pain and swelling. Despite conflicting results from a recent study to prevent post-thrombotic syndrome, medical compression stockings are still recommended. In thromboprophylaxis, the role of stockings in addition to anticoagulation is limited. For the maintenance phase of lymphoedema management, compression stockings are the most important intervention. Conclusion The beneficial value of applying compression stockings in the treatment of venous and lymphatic disease is supported by this document, with 19/25 recommendations rated as Grade 1 evidence. For recommendations rated with Grade 2 level of evidence, further studies are needed.
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Affiliation(s)
- Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - Hugo Partsch
- Department of Dermatology, Medical University of Vienna, Austria
| | - Juerg Hafner
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Christopher Lattimer
- Josef Pflug Vascular Laboratory, West London Vascular and Interventional Centre, Ealing Hospital & Imperial College, London, UK
| | - Giovanni Mosti
- Angiology Department, Clinica MD Barbantini, Lucca, Italy
| | - Martino Neumann
- Department of Dermatology, Erasmus University Hospital, Rotterdam, The Netherlands
| | - Tomasz Urbanek
- Medical University of Silesia Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Katowice, Poland
| | | | | | - Patrick Carpentier
- Centre de Recherche Universitaire de La Léchère, Equipe THEMAS, Université Joseph Fourier, Grenoble, France
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Prevention and treatment of the post-thrombotic syndrome. Thromb Res 2018; 164:116-124. [DOI: 10.1016/j.thromres.2017.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/19/2017] [Accepted: 07/10/2017] [Indexed: 11/21/2022]
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ten Cate‐Hoek AJ. Prevention and treatment of the post-thrombotic syndrome. Res Pract Thromb Haemost 2018; 2:209-219. [PMID: 30046723 PMCID: PMC6055553 DOI: 10.1002/rth2.12085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/14/2018] [Indexed: 11/12/2022] Open
Abstract
Post thrombotic syndrome (PTS) is a common chronic complication of deep vein thrombosis of the leg (DVT). Treatment options are limited therefore emphasis is placed on its prevention. Several risk factors have been recognized, but were so far not used for risk stratification or translation into prediction models. Early interventions did not yet result in more successful preventive treatment strategies; for the acute phase of DVT there is equipoise on the value of elastic compression, as well as on catheter directed thrombolysis. There are no drugs specifically targeted at PTS prevention. The use of anticoagulant medication such as direct oral anticoagulants (DOACs) might decrease PTS incidence, but this needs to be corroborated. Both research into more effective treatment options as well as future PTS management may benefit from a uniform diagnostic strategy and the use of prediction rules to better allocate treatment and thereby increase treatment efficacy.
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Affiliation(s)
- Arina J. ten Cate‐Hoek
- Heart+ and Vascular Center, Internal MedicineCardiovascular Research InstituteMaastricht University Medical CenterMaastrichtthe Netherlands
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A Summation Analysis of Compliance and Complications of Compression Hosiery for Patients with Chronic Venous Disease or Post-thrombotic Syndrome. Eur J Vasc Endovasc Surg 2018; 55:406-416. [DOI: 10.1016/j.ejvs.2017.11.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/27/2017] [Indexed: 01/23/2023]
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ten Cate-Hoek AJ, Amin EE, Bouman AC, Meijer K, Tick LW, Middeldorp S, Mostard GJM, ten Wolde M, van den Heiligenberg SM, van Wissen S, van de Poel MHW, Villalta S, Serné EH, Otten HM, Klappe EH, Bistervels IM, Lauw MN, Piersma-Wichers M, Prandoni P, Joore MA, Prins MH, ten Cate H, ten Cate-Hoek AJ, ten Cate H, Joore MA, Prins MH, Amin EE, Bouman AC, Meijer K, Piersma-Wichers M, Tick LW, Nijziel MR, Middeldorp S, Lauw M, Cheung YW, Mostard GJM, ten Wolde M, Bistervels IM, van den Heiligenberg SM, van Wissen S, van de Poel MHW, Otten HM, Serné EH, Klappe EH, Prandoni P, Vedovetto V, Villalta S. Individualised versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL DVT): a multicentre, randomised, single-blind, allocation-concealed, non-inferiority trial. LANCET HAEMATOLOGY 2018; 5:e25-e33. [DOI: 10.1016/s2352-3026(17)30227-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022]
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Kaspar M, Imfeld S, Partovi S, Aschwanden M, Baldi T, Dikkes A, Vogt DR, Tsakiris DA, Staub D. Perivascular Perfusion on Contrast-Enhanced Ultrasound (CEUS) Is Associated with Inflammation in Patients with Acute Deep Vein Thrombosis. Thromb Haemost 2017; 117:2146-2155. [PMID: 28933797 DOI: 10.1160/th17-05-0332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Inflammatory processes of the venous wall in acute deep vein thrombosis (DVT) play a role in thrombus formation and resolution. However, direct evaluation of the perivascular inflammation is currently not feasible. Objective To assess perivascular perfusion in acute proximal DVT using contrast-enhanced ultrasound (CEUS) reflecting perivenous inflammation and its association with systemic inflammatory markers in a single-centre, prospective observational study. Patients/Methods Twenty patients with proximal DVT underwent CEUS imaging in the thrombosed and contralateral popliteal vein at baseline and after 2 weeks and 3 months. Perfusion was quantified by measuring peak enhancement (PE) and wash-in rate (WiR) in a perivenous region after bolus injection of the contrast agent. High-sensitive C-reactive protein (hsCRP) and interleukin-6 (IL-6) were determined at the time of each CEUS imaging. Results PE and WiR were significantly higher in the thrombosed compared with the unaffected leg at baseline (1,007 vs. 34 au and 103 vs. 4 au/s) and 2-week follow-up (903 vs. 35 au and 70 vs. 4 au/s). Compared with baseline, PE and WiR in the thrombosed leg significantly decreased to 217 au and 18 au/s at 3-month follow-up.At baseline, hsCRP and IL-6 were elevated at 20.1 mg/mL and 8.2 pg/mL and decreased significantly to 2.8 mg/mL and 2.6 pg/mL at 2-week follow-up, remaining low after 3 months. There was a weak association between the level of inflammatory markers and the CEUS parameters at baseline on the thrombosed leg. Conclusion Elevated perivascular perfusion assessed by CEUS imaging is associated with the inflammatory response in acute DVT.
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Affiliation(s)
- Mathias Kaspar
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Stephan Imfeld
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
| | - Markus Aschwanden
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Thomas Baldi
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Alexander Dikkes
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Deborah R Vogt
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland
| | - Dimitrios A Tsakiris
- Department of Diagnostic Haematology, University Hospital Basel, University of Basel, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
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Appelen D, van Loo E, Prins MH, Neumann MHAM, Kolbach DN. Compression therapy for prevention of post-thrombotic syndrome. Cochrane Database Syst Rev 2017; 9:CD004174. [PMID: 28950030 PMCID: PMC6483721 DOI: 10.1002/14651858.cd004174.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) that is characterised by chronic pain, swelling, and skin changes in the affected limb. One of every three people with DVT will develop post-thrombotic complications within five years. Several non-pharmaceutical measures are used for prevention of post-thrombotic syndrome during the acute phase of DVT. These include elevation of the legs and compression therapy. Clinicians and guidelines differ in their assessment of the utility of compression therapy for treatment of DVT. This is an update of a review first published in 2003. OBJECTIVES To determine relative effectiveness and rate of complications when compression therapy is used in people with deep vein thrombosis (DVT) for prevention of post-thrombotic syndrome (PTS). SEARCH METHODS For this update, the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (20 March 2017) and CENTRAL (2017, Issue 2). The CIS also searched trial registries for details of ongoing or unpublished studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of compression therapy, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS. DATA COLLECTION AND ANALYSIS Two review authors (DK and EvL) identified and assessed titles and abstracts for relevance, and a third review author (DA) verified this assessment independently. Review authors imposed no restrictions on date or language of publications. Three review authors (DA, DK, EvL) used data extraction sheets to independently extract study data. We resolved disagreements by discussion. MAIN RESULTS We identified 10 RCTs with a total of 2361 participants that evaluated compression therapy. The overall methodological quality of these trials was low. We used only five studies in meta-analysis owing to differences in intervention types and lack of data. Three studies compared elastic compression stockings (pressure of 30 to 40 mmHg at the ankle) versus no intervention. Two studies compared elastic compression stockings (pressure 20 to 40 mmHg) versus placebo stockings. Overall, use of elastic compression stockings led to a clinically significant reduction in the incidence of PTS (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.38 to 1.01; P = 0.05; 1393 participants; 5 studies; low-quality evidence); no reduction in the incidence of severe PTS (RR 0.78, 95% CI 0.53 to 1.15; P = 0.21; 1224 participants; 4 studies; low-quality evidence); and no clear difference in DVT recurrence (RR 0.94, 95% CI 0.69 to 1.28; 1212 participants; 4 studies; P = 0.69; low-quality evidence). We did not pool data on the incidence of pulmonary embolism because this information was poorly reported, but we observed no differences between groups included in individual studies (low-quality evidence).Two studies evaluated effects of compression in the acute phase versus no compression treatment and found no differences in the incidence of PTS (RR 0.76, 95% CI 0.49 to 1.16; P = 0.2; 101 participants). One study reported that thigh-length stockings did not provide better protection against development of PTS than knee-length stockings (RR 0.92, 95% CI 0.66 to 1.28; P = 0.6; 267 participants). Another trial reported that wearing compression stockings for two years seemed to be superior to wearing them for one year in terms of PTS incidence.Two of the 10 included studies described patient satisfaction and quality of life (moderate-quality evidence), using different measurement systems. The first study showed significant improvement in well-being and DVT-related quality of life with compression treatment (P < 0.05) compared with bed rest, and the second study showed no differences in quality of life scores between compression and placebo groups. Four studies poorly reported side effects (low-quality evidence) that included itching, erythema, and other forms of allergic reaction and described no serious adverse events. Compliance with wearing of compression stockings was generally high but varied across studies. AUTHORS' CONCLUSIONS Low-quality evidence suggests that elastic compression stockings may reduce the occurrence of PTS after DVT. We downgraded the quality of evidence owing to considerable heterogeneity between studies and lack of or unclear risk of blinding due to clinical assessment scores. No serious adverse effects occurred in these studies. Large randomised controlled trials are needed to confirm these findings because of current lack of high-quality evidence and considerable heterogeneity.
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Affiliation(s)
- Diebrecht Appelen
- Huidcentrum LimburgDepartment of DermatologyReinaartsingel 50MaastrichtNetherlands
| | - Eva van Loo
- Maastricht University Medical CenterDepartment of DermatologyMaastrichtNetherlands
| | - Martin H Prins
- CAPHRI Research School, Maastricht UniversityDepartment of EpidemiologyMaastrichtNetherlands6200 MD
| | - Martino HAM Neumann
- Erasmus Medical CenterDepartment of DermatologyPO Box 2040RotterdamNetherlands3000 CA
| | - Dinanda N Kolbach
- Huidcentrum LimburgDepartment of DermatologyReinaartsingel 50MaastrichtNetherlands
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Chi YW, Durbin-Johnson B, Schul M. Short-form 6D assessment in compression module of the American College of Phlebology Patient Reported Outcome Venous Registry. Phlebology 2017. [PMID: 28639875 DOI: 10.1177/0268355517717425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The goal of this American College of Phlebology Patient Reported Outcome Venous Registry analysis was to examine the clinical efficacy of compression stockings using short-form 6D questionnaire (SF-6D). Method SF-6D scores were modeled over time using linear mixed effects model. Changes of SF-6D score from baseline to the last encounter were examined using a paired t-test. Analysis of variance was used to compare changes from baseline in SF-6D scores between C classifications. All analyses were conducted using SAS software, version 9.4 (SAS Institute, Cary NC). Results Baseline mean SF-6D score was 0.83 and at follow-up, 0.85. Mean SF-6D change was +0.02 points (P = .001) over an average time period of 5.5 months. Patients' SF-6D scores were estimated to increase by +0.03 points (P = .005) per year of usage of compression stockings. SF-6D score changes across C classifications did not demonstrate significant differences (P = .265). Conclusion There was an improvement of SF-6D score in the registry participants who used circular knit compression stockings.
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Affiliation(s)
- Yung-Wei Chi
- 1 Vascular Center, University of California, Davis Medical Center, Sacramento, CA, USA
| | | | - Marlin Schul
- 3 Indiana Vascular Associates, LLC, Lafayette, IN, USA
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Becattini C, Agnelli G. Treatment of Venous Thromboembolism With New Anticoagulant Agents. J Am Coll Cardiol 2016; 67:1941-55. [PMID: 27102510 DOI: 10.1016/j.jacc.2016.01.072] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/19/2016] [Accepted: 01/26/2016] [Indexed: 12/21/2022]
Abstract
Venous thromboembolism (VTE) is a common disease associated with high risk for recurrences, death, and late sequelae, accounting for substantial health care costs. Anticoagulant agents are the mainstay of treatment for deep vein thrombosis and pulmonary embolism. The recent availability of oral anticoagulant agents that can be administered in fixed doses, without laboratory monitoring and dose adjustment, is a landmark change in the treatment of VTE. In Phase III trials, rivaroxaban, apixaban, edoxaban (antifactor Xa agents), and dabigatran (an antithrombin agent) were noninferior and probably safer than conventional anticoagulation therapy (low-molecular-weight heparin followed by vitamin K antagonists). These favorable results were confirmed in specific patient subgroups, such as the elderly and fragile. However, some patients, such as those with cancer or with intermediate- to high-risk pulmonary embolism, were underrepresented in the Phase III trials. Further clinical research is required before new oral anticoagulant agents can be considered standard of care for the full spectrum of patients with VTE.
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Affiliation(s)
- Cecilia Becattini
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
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Jin YW, Ye H, Li FY, Xiong XZ, Cheng NS. Compression Stockings for Prevention of Postthrombotic Syndrome: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2016; 50:328-34. [PMID: 27260750 DOI: 10.1177/1538574416652242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The present meta-analysis aimed to evaluate the efficacy and safety of compression stockings for postthrombotic syndrome (PTS) prevention in patients with deep venous thrombosis (DVT). METHODS Randomized controlled trials (RCTs) regarding the use of compression stockings for prevention of PTS were identified from the Medline, PubMed, and Embase databases as well as the Cochrane library. The resulting manuscripts were analyzed according to the criteria in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Six RCTs involving 1465 patients with DVT were included. The meta-analysis indicated no statistical differences between the compression stocking and the control groups in PTS incidence, using either the Villalta scale (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.23-1.74) or the Ginsberg scale (OR, 1.13; 95% CI, 0.72-1.77). Based on the Villalta scale categorization, there were no differences in the incidence of mild-moderate PTS (OR, 0.71; 95% CI, 0.36-1.41) or incidence of severe PTS (OR, 0.68; 95% CI, 0.15-3.11). The difference in the recurrence of venous thromboembolism (OR, 0.89; 95% CI, 0.61-1.30) was also not significant. In the 3 RCTs that reported side effects of compression stockings, they were primarily related to discomfort, including itching, erythema, and rash. CONCLUSION The present meta-analysis has indicated that compression stockings may not prevent PTS, as determined by either the Villalta or the Ginsberg scale, in patients with DVT. However, owing to the limited number of trials, the evidence is not strong enough to draw a reliable conclusion. Further larger, randomized, double-blind, placebo-controlled, multicenter trials are needed.
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Affiliation(s)
- Y W Jin
- General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - H Ye
- General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - F Y Li
- General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - X Z Xiong
- General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - N S Cheng
- General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Subbiah R, Aggarwal V, Zhao H, Kolluri R, Chatterjee S, Bashir R. Effect of compression stockings on post thrombotic syndrome in patients with deep vein thrombosis: a meta-analysis of randomised controlled trials. LANCET HAEMATOLOGY 2016; 3:e293-300. [DOI: 10.1016/s2352-3026(16)30017-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
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Skervin A, Thapar A, Franchini A, Prandoni P, Shalhoub J, Davies A. Systematic Review and Meta-Analysis of Utility of Graduated Compression Stockings in Prevention of Post-Thrombotic Syndrome. Eur J Vasc Endovasc Surg 2016; 51:838-45. [DOI: 10.1016/j.ejvs.2016.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
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Mol GC, van de Ree MA, Klok FA, Tegelberg MJAM, Sanders FBM, Koppen S, de Weerdt O, Koster T, Hovens MMC, Kaasjager HAH, Brouwer RE, Kragten E, Schaar CG, Spiering W, Arnold WP, Biesma DH, Huisman MV. One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): randomised controlled trial. BMJ 2016; 353:i2691. [PMID: 27245485 PMCID: PMC4886508 DOI: 10.1136/bmj.i2691] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To study whether stopping elastic compression stockings (ECS) after 12 months is non-inferior to continuing them for 24 months after proximal deep venous thrombosis. DESIGN Multicentre single blind non-inferiority randomised controlled trial. SETTING Outpatient clinics in eight teaching hospitals in the Netherlands, including one university medical centre. PARTICIPANTS Patients compliant with compression therapy for 12 months after symptomatic, ultrasound proven proximal deep venous thrombosis of the leg. INTERVENTIONS Continuation or cessation of ECS 12 months after deep venous thrombosis. MAIN OUTCOME MEASURES The primary outcome was the incidence of post-thrombotic syndrome 24 months after diagnosis of deep venous thrombosis, as assessed by the standardised Villalta scale in an intention to treat analysis. The predefined non-inferiority margin was 10%. The main secondary outcome was quality of life (VEINES-QOL/Sym). RESULTS 518 patients compliant with ECS and free of post-thrombotic syndrome were randomised one year after diagnosis of deep venous thrombosis to stop or continue ECS therapy for another year. In the stop-ECS group, 51 of 256 patients developed post-thrombotic syndrome, with an incidence of 19.9% (95% confidence interval 16% to 24%). In the continue-ECS group, 34 of 262 patients developed post-thrombotic syndrome (incidence 13.0%, 9.9% to 17%), of whom 85% used ECS six or seven days a week during the study period, for an absolute difference of 6.9% (95% confidence interval upper limit 12.3%). Because the upper limit of the 95% confidence interval exceeds the predefined margin of 10%, non-inferiority was not reached. The number needed to treat to prevent one case of post-thrombotic syndrome by continuing ECS was 14 (95% confidence interval lower limit 8). Quality of life did not differ between the two groups. CONCLUSION Stopping ECS after one year in compliant patients with proximal deep venous thrombosis seemed not to be non-inferior to continuing ECS therapy for two years in this non-inferiority trial. TRIAL REGISTRATION Netherlands Trial Register NTR1442.
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Affiliation(s)
- G C Mol
- Department of Internal Medicine, Diakonessenhuis Hospital, Utrecht, Netherlands Department of Internal Medicine, University Medical Center, Utrecht, Netherlands Department of Vascular Medicine, University Medical Center, 3508 GA Utrecht, Netherlands
| | - M A van de Ree
- Department of Internal Medicine, Diakonessenhuis Hospital, Utrecht, Netherlands
| | - F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
| | - M J A M Tegelberg
- Department of Dermatology, Diakonessenhuis Hospital, Utrecht, Netherlands
| | - F B M Sanders
- Department of Radiology, Diakonessenhuis Hospital, Utrecht, Netherlands
| | - S Koppen
- Department of Dermatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - O de Weerdt
- Department of Hematology, St Antonius Hospital, Nieuwegein, Netherlands
| | - T Koster
- Department of Internal Medicine, Groene Hart Hospital, Gouda, Netherlands
| | - M M C Hovens
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands
| | - H A H Kaasjager
- Department of Internal Medicine, University Medical Center, Utrecht, Netherlands
| | - R E Brouwer
- Department of Hematology, Reinier de Graaf Group, Delft, Netherlands
| | - E Kragten
- Department of Hematology, Reinier de Graaf Group, Delft, Netherlands
| | - C G Schaar
- Department of Internal Medicine, Gelre Hospitals, Apeldoorn, Netherlands
| | - W Spiering
- Department of Vascular Medicine, University Medical Center, 3508 GA Utrecht, Netherlands
| | - W P Arnold
- Department of Dermatology, Gelderse Vallei Hospital, Ede, Netherlands
| | - D H Biesma
- Department of Hematology, St Antonius Hospital, Nieuwegein, Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
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Berntsen CF, Kristiansen A, Akl EA, Sandset PM, Jacobsen EM, Guyatt G, Vandvik PO. Compression Stockings for Preventing the Postthrombotic Syndrome in Patients with Deep Vein Thrombosis. Am J Med 2016; 129:447.e1-447.e20. [PMID: 26747198 DOI: 10.1016/j.amjmed.2015.11.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to address benefits and harms of using elastic compression stockings after lower-extremity deep vein thrombosis. METHODS We searched 7 electronic databases through January 15, 2015, including randomized controlled trials (RCTs)/quasi-randomized trials reporting on elastic compression stocking efficacy on postthrombotic syndrome incidence, recurrent venous thromboembolism, mortality, and acute pain after deep vein thrombosis. Two reviewers independently screened records, extracted data, assessed risk of bias, and assessed confidence in effect estimates using Grading of Recommendations Assessment, Development, and Evaluation methodology. We applied random-effects meta-analysis models. RESULTS We included 5 RCTs (n = 1418) reporting on postthrombotic syndrome. The hazard ratio (HR) for postthrombotic syndrome with elastic compression stockings was 0.69 (95% confidence interval [CI], 0.47-1.02). We have very low confidence in this estimate due to heterogeneity and inclusion of unblinded studies at high risk of bias. Excluding high risk of bias studies, a single large RCT at low risk of bias provided moderate-quality evidence of no effect on postthrombotic syndrome (HR 1.00; 95% CI, 0.81-1.24). Moderate-quality evidence including all 5 studies suggests no effect of elastic compression stockings on recurrent venous thromboembolism (relative risk [RR] 0.88; 95% CI, 0.63-1.24) or mortality (RR 1.00; 95% CI, 0.73-1.37, 5 studies). Moderate-quality evidence from one large RCT does not suggest effect on acute pain after deep vein thrombosis. CONCLUSIONS The highest-quality evidence available suggests no effect of elastic compression stockings on postthrombotic syndrome or pain relief, from a single large RCT. However, results for preventing postthrombotic syndrome differ substantially across studies, and future guideline updates should reflect uncertainty about treatment effects. Elastic compression stockings are unlikely to prevent death or recurrent venous thromboembolism.
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Affiliation(s)
- Christopher Friis Berntsen
- Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Annette Kristiansen
- Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Lebanon
| | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Eva-Marie Jacobsen
- Department of Haematology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Per Olav Vandvik
- Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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Behrendt CA, Heidemann F, Rieß HC, Kleinspehn E, Kühme T, Atlihan G, Gebhardt C, Debus ES. Open surgical treatment for postthrombotic syndrome. Phlebology 2016; 31:48-55. [PMID: 26916769 DOI: 10.1177/0268355516633016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The postthrombotic syndrome counts as a frequent long-term complication after deep vein thrombosis with approximately 20%–50% of affected patients after deep vein thrombosis. The earliest that diagnosis of postthrombotic syndrome can be made is 6 months after deep vein thrombosis. Most patients suffer from swelling and chronic pain. In all, 5%–10% of patients may even develop venous ulcers. The complex etiology consists of limited venous drainage because of chronic occlusions and secondary insufficiencies of venous valves inducing non-physiological venous reflux. Conservative management, first of all compression therapy, is of crucial importance in treatment of postthrombotic syndrome. Endovascular and open surgical techniques can additionally be used in a small subgroup of patients. Although rarely performed, this article illuminates the open surgical techniques in treatment of postthrombotic syndrome such as venous bypass surgery, valve repair and varicose vein surgery.
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Affiliation(s)
- Christian-Alexander Behrendt
- University Medical Center Hamburg-Eppendorf, University Heart Center Hamburg, Department of Vascular Medicine, Martinistr, Hamburg, Germany
| | - Franziska Heidemann
- University Medical Center Hamburg-Eppendorf, University Heart Center Hamburg, Department of Vascular Medicine, Martinistr, Hamburg, Germany
| | - Henrik Christian Rieß
- University Medical Center Hamburg-Eppendorf, University Heart Center Hamburg, Department of Vascular Medicine, Martinistr, Hamburg, Germany
| | - Edgar Kleinspehn
- University Medical Center Hamburg-Eppendorf, University Heart Center Hamburg, Department of Vascular Medicine, Martinistr, Hamburg, Germany
| | - Tobias Kühme
- University Medical Center Hamburg-Eppendorf, University Heart Center Hamburg, Department of Vascular Medicine, Martinistr, Hamburg, Germany
| | - Gülsen Atlihan
- University Medical Center Hamburg-Eppendorf, University Heart Center Hamburg, Department of Vascular Medicine, Martinistr, Hamburg, Germany
| | | | - Eike Sebastian Debus
- University Medical Center Hamburg-Eppendorf, University Heart Center Hamburg, Department of Vascular Medicine, Martinistr, Hamburg, Germany
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