Venous Thromboembolism: Pharmacological and Nonpharmacological Interventions

A randomized controlled trial of a mixed Kinesio taping–compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency

Objectives:

To investigate the effect of a mixed Kinesio taping treatment in women with chronic venous insufficiency.

Design:

A double-blinded randomized clinical trial.

Setting:

Clinical setting.

Participants:

One hundred and twenty postmenopausal women with mild–moderate chronic venous insufficiency were randomly assigned to an experimental group receiving standardized Kinesio taping treatment for gastrocnemius muscle enhancement and ankle functional correction, or to a placebo control group for simulated Kinesio taping.

Main outcomes variables:

Venous symptoms, pain, photoplethysmographic measurements, bioelectrical impedance, temperature, severity and overall health were recorded at baseline and after four weeks of treatment.

Results:

The 2 × 2 mixed model ANCOVA with repeated measurements showed statistically significant group * time interaction for heaviness ( F = 22.99, p = 0.002), claudication ( F = 8.57, p = 0.004), swelling ( F = 22.58, p = 0.001), muscle cramps ( F = 7.14, p = 0.008), venous refill time (right: F = 9.45, p = 0.023; left: F = 14.86, p = 0.001), venous pump function (right: F = 35.55, p = 0.004; left: F = 17.39 p = 0.001), extracellular water (right: F = 35.55, p = 0.004; left: F = 23.84, p = 0.001), severity ( F = 18.47, p = 0.001), physical function ( F = 9.15, p = 0.003) and body pain ( F = 3.36, p = 0.043). Both groups reported significant reduction in pain.

Conclusion:

Mixed Kinesio taping-compression therapy improves symptoms, peripheral venous flow and severity and slightly increases overall health status in females with mild chronic venous insufficiency. Kinesio taping may have a placebo effect on pain.

Venous thromboembolism: classification, risk factors, diagnosis, and management

Venous thromboembolism (VTE) is categorised as deep venous thrombosis (DVT) and pulmonary embolism (PE). VTE is associated with high morbidity and causes a huge financial burden on patients, hospitals, and governments. Both acquired and hereditary risks factors contribute to VTE. To diagnose VTE, noninvasive cost-effective diagnostic algorithms including clinical probability assessment and D-dimer measurement may be employed followup by compression ultrasonography for suspected DVT patients and multidetector computed tomography angiography for suspected PE patients. There are pharmacological and mechanical interventions to manage and prevent VTE. The pharmacological approaches mainly target pathways in coagulation cascade nonspecifically: conventional anticoagulants or specifically: new generation of anticoagulants. Excess bleeding is one of the major risk factors for pharmacological interventions. Hence, nonpharmacological or mechanical approaches such as inferior vena cava filters, graduated compression stockings, and intermittent pneumatic compression devices in combination with pharmacological interventions or alone may be a good approach to manage VTE.

Problems with measuring compression device performance in preventing deep vein thrombosis

The purpose of this article is to discuss issues related to the use and performance of mechanical compression devices in preventing deep vein thrombosis (DVT), such as graduated compression stockings (GCSs) and pneumatic compression devices (PCDs). While various studies have shown mechanical compression to be effective against DVT, the adequacy of the performance of these devices has not been conclusively determined. One reason for this inconclusiveness is small sample bias in which the results of many studies are open to a considerable chance of error. Another problem is that the studies may not be appropriate designed to measure device effectiveness and be free of bias. In addition, new methods of DVT prophylaxis are forcing a reexamination of what it means for a device to be "effective." Finally, the prevention of DVT is not likely to occur if the patient declines to comply with a prescribed treatment. Compliance is particularly bad with GCSs and some compliance comparisons on PCDs have suffered from failing to control for potentially confounding factors. As such, more and better studies need to be performed on these devices.