Efficacy of a short course of complex lymphedema therapy or graduated compression stocking therapy in the treatment of post-thrombotic syndrome

Holmes, Chris E.; Bambace, Nadia M.; Lewis, Patricia; Callas, Peter W.; Cushman, Mary

doi:10.1177/1358863x14521883

Cited by 22 publications

(22 citation statements)

References 36 publications

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“…The Villalta PTS scale has been shown to be valid, reproducible, and responsive to clinical change, and is easy to administer [ 27 ]. The Villalta PTS scale has been used to diagnose PTS in a number of recent randomized trials of interventions to prevent and treat PTS [ 28 – 32 ]. Additional diagnostic scales have been used to assess PTS, including the CAEP classification and Ginsberg measure; these are discussed in reference 2.…”

Section: Guidancementioning

confidence: 99%

Guidance for the prevention and treatment of the post-thrombotic syndrome

Kahn

Galanaud

Vedantham

et al. 2016

J Thromb Thrombolysis

150

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The post-thrombotic syndrome (PTS) is a frequent, potentially disabling complication of deep vein thrombosis (DVT) that reduces quality of life and is costly. Clinical manifestations include symptoms and signs such as leg pain and heaviness, edema, redness, telangiectasia, new varicose veins, hyperpigmentation, skin thickening and in severe cases, leg ulcers. The best way to prevent PTS is to prevent DVT with pharmacologic or mechanical thromboprophylaxis used in high risk patients and settings. In patients whose DVT is treated with a vitamin K antagonist, subtherapeutic INRs should be avoided. We do not suggest routine use of elastic compression stockings (ECS) after DVT to prevent PTS, but in patients with acute DVT-related leg swelling that is bothersome, a trial of ECS is reasonable. We suggest that selecting patients for catheter-directed thrombolytic techniques be done on a case-by-case basis, with a focus on patients with extensive thrombosis, recent symptoms onset, and low bleeding risk, who are seen at experienced hospital centers. For patients with established PTS, we suggest prescribing 20–30 mm Hg knee-length ECS to be worn daily. If ineffective, a stronger pressure stocking can be tried. We suggest that intermittent compression devices or pneumatic compression sleeve units be tried in patients with moderate-to-severe PTS whose symptoms are inadequately controlled with ECS alone. We suggest that a supervised exercise training program for 6 months or more is reasonable for PTS patients who can tolerate it. We suggest that management of post-thrombotic ulcers should involve a multidisciplinary approach. We briefly discuss upper extremity PTS and PTS in children.

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Section: Guidancementioning

confidence: 99%

Guidance for the prevention and treatment of the post-thrombotic syndrome

Kahn

Galanaud

Vedantham

et al. 2016

J Thromb Thrombolysis

150

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“…At this stage the overall conclusion is that the quality of evidence is low, but that the overall direction of the effect is more towards a favourable effect of ECS as an intervention with a potential for PTS prevention (RR 0.62, 95% CI 0.38-1.01; P = .05). 35 In addition, most investigated interventions for established PTS were directed at the reduction of edema and enhancement of calf muscle pump action including complex lymphedema therapy, 36 veno-wave therapy, 37 or exercise therapy, 38,39 all with or without additional elastic compression therapy. All interventions resulted in an improvement in the severity of PTS, [36][37][38][39] and all but one resulted also in an improved health-related quality of life (HRQoL).…”

Section: One Standard Treatment For All Patientsmentioning

confidence: 99%

“…35 In addition, most investigated interventions for established PTS were directed at the reduction of edema and enhancement of calf muscle pump action including complex lymphedema therapy, 36 veno-wave therapy, 37 or exercise therapy, 38,39 all with or without additional elastic compression therapy. All interventions resulted in an improvement in the severity of PTS, [36][37][38][39] and all but one resulted also in an improved health-related quality of life (HRQoL). 36 Complex lymphedema therapy on top of elastic compression therapy was only superior in patients with severe PTS 36 while other studies such as the veno-wave study were solely directed at patients with severe PTS.…”

Section: One Standard Treatment For All Patientsmentioning

confidence: 99%

“…All interventions resulted in an improvement in the severity of PTS, [36][37][38][39] and all but one resulted also in an improved health-related quality of life (HRQoL). 36 Complex lymphedema therapy on top of elastic compression therapy was only superior in patients with severe PTS 36 while other studies such as the veno-wave study were solely directed at patients with severe PTS. 37 In addition to these mechanical studies, a limited number of pharmacological studies in which veno active drugs (VADs) were investigated for their properties of edema reduction and improvement of PTS symptomatology have been performed; the quality of evidence is, however, deemed to be low.…”

Section: One Standard Treatment For All Patientsmentioning

confidence: 99%

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Prevention and treatment of the post‐thrombotic syndrome

Cate‐Hoek

2018

Research and Practice in Thrombosis and Haemostasis

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Essentials Post thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) with limited treatment options.Uniformity of the diagnostic strategy and the use of risk prediction models might improve treatment outcomes.Extending knowledge on the pathophysiology and improving therapeutic options is paramount for progress. PTS management should evolve to a multimodal approach with treatment tailored to individual patients' needs. 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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“…Villalta PTS scores improved from moderate to mild over 3 months with either therapy. 41 The latest scientific statement from the American Heart Association recommends 6 months of exercise training in patients with PTS who can tolerate it, 2 but additional research is warranted.…”

Section: Exercise Trainingmentioning

confidence: 99%

Medical Treatment for Postthrombotic Syndrome

Palacios

Rathbun

2017

Semin intervent Radiol

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Deep vein thrombosis (DVT) is a prevalent disease. About 20 to 30% of patients with DVT will develop postthrombotic syndrome (PTS) within months after the initial diagnosis of DVT. There is no gold standard for diagnosis of PTS, but clinical signs include pitting edema, hyperpigmentation, phlebectatic crown, venous eczema, and varicose veins. Several scoring systems have been developed for diagnostic evaluation. Conservative treatment includes compression therapy, medications, lifestyle modification, and exercise. Compression therapy, the mainstay and most proven noninvasive therapy for patients with PTS, can be prescribed as compression stockings, bandaging, adjustable compression wrap devices, and intermittent pneumatic compression. Medications may be used to both prevent and treat PTS and include anticoagulation, anti-inflammatories, vasoactive drugs, antibiotics, and diuretics. Exercise, weight loss, smoking cessation, and leg elevation are also recommended. Areas of further research include the duration, compliance, and strength of compression stockings in the prevention of PTS after DVT; the use of intermittent compression devices; the optimal medical anticoagulant regimen after endovascular therapy; and the role of newer anticoagulants as anti-inflammatory agents.

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Efficacy of a short course of complex lymphedema therapy or graduated compression stocking therapy in the treatment of post-thrombotic syndrome

Cited by 22 publications

References 36 publications

Guidance for the prevention and treatment of the post-thrombotic syndrome

Guidance for the prevention and treatment of the post-thrombotic syndrome

Prevention and treatment of the post‐thrombotic syndrome

Medical Treatment for Postthrombotic Syndrome

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