Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis

Amin, Elham E.; Bistervels, Ingrid M.; Meijer, Karina; Tick, Lidwine W.; Middeldorp, Saskia; Mostard, Guy J M; Poel, Marlène van de; Serné, Erik H.; Otten, Hans Martin; Klappe, E.M.; Joore, Manuela A.; Cate, Hugo Ten; Wolde, Marije ten; Cate‐Hoek, Arina J. ten

doi:10.1182/blood-2018-03-836783

Cited by 48 publications

(66 citation statements)

References 37 publications

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“…In the IDEAL DVT study, compression stockings worn for at least a minimum of 6 months until the Villalta score decreased to 4 or less on two consecutive readings, compared with 2 years, were non‐inferior for preventing PTS in patients with acute proximal DVT (29% v 28%; odds ratio [OR], 1.06; 95% CI, 0.78–1.44) . In a pre‐specified substudy of the IDEAL DVT study, acute compression of the leg within 24 hours of DVT diagnosis, compared with no compression, was associated with a decrease in residual vein obstruction (46% v 66%; OR, 0.46; 95% CI, 0.27–0.80) and PTS (46% v 54%; OR, 0.65; 95% CI, 0.46–0.92) …”

Section: Managementmentioning

confidence: 99%

Deep vein thrombosis: update on diagnosis and management

Krüger

Eikelboom

Douketis

et al. 2019

Medical Journal of Australia

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Summary Diagnosis of deep vein thrombosis (DVT) requires a multifaceted approach that includes clinical assessment, evaluation of pre‐test probability, and objective diagnostic testing. Common symptoms and signs of DVT are pain, swelling, erythema and dilated veins in the affected limb. The pre‐test probability of DVT can be assessed using a clinical decision rule that stratifies DVT into “unlikely” or “likely”. If DVT is “unlikely”, refer for D‐dimer test. If the D‐dimer level is normal, DVT can be excluded; if the D‐dimer level is increased, refer for compression ultrasound. If DVT is “likely”, refer for compression ultrasound. When DVT is confirmed, anticoagulation is indicated to control symptoms, prevent progression and reduce the risk of post‐thrombotic syndrome and pulmonary embolism. Anticoagulation may consist of a parenteral anticoagulant overlapped by warfarin or followed by a direct oral anticoagulant (DOAC) (dabigatran or edoxaban), or of a DOAC (apixaban or rivaroxaban) without initial parenteral therapy. DOACs are the preferred treatment for DVT because they are at least as effective, safer and more convenient than warfarin. DOACs may require dose reduction or avoidance in patients with renal dysfunction, and should be avoided in pregnancy. Recent evidence shows that DVT in patients with cancer may be treated with edoxaban (after discontinuation of 5 days of initial heparin or low molecular weight heparin [LMWH]) or rivaroxaban if patients prefer not to have daily injections of LMWH, but the risk of gastrointestinal bleeding is higher with DOACs than with LMWH in patients with gastrointestinal cancer.

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Section: Managementmentioning

confidence: 99%

Deep vein thrombosis: update on diagnosis and management

Krüger

Eikelboom

Douketis

et al. 2019

Medical Journal of Australia

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“…The strongest independent risk factor for the development of PTS was leg swelling, presumably caused by venous obstruction by extensive thrombi. In a previous report, the presence of residual venous symptoms 1 month after the DVT diagnosis was a strong risk factor for PTS 6 , suggesting that early treatment to release the venous obstruction might be important for the prevention of PTS. We investigated the clinical prognosis after 1 year of CRT onset for 30 cases whose CRT was pointed out in ISV at our hospital from 2010 to 2017.…”

Section: Resultsmentioning

confidence: 85%

“…Key word: Abdominal Aortic Aneurysm, biomarker, SEP, MMP-9, cystatin-C Pathology Concept of AAA Congenital pathologies: Marfan syndrome, Ehlers-Danlos syndrome, elastin deficiency, etc 9 AAA Slimmer and rigidity of aortic wall. ECM Degradation (MMP-9) 7 Aortic wall stretching (Cystatin-C) 5,6 Aortic wall inflammation (SEP) 4 Background and Aim: Catheter-directed thrombolysis (CDT) can reduce the incidence of post-thrombotic syndrome in certain patients with acute deep venous thrombosis (DVT). Thrombus age, based on history, is however, often unreliable and understanding the structural composition of the thrombus may be a better indicator of successful lysis.…”

Section: Introductionmentioning

confidence: 99%

抄録1・2日目

2019

Jpn J Phlebol

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Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after 3 years in average, one out of 5 recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211-1219). The present lecture reports the literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries guidelines trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts opinions are also provided. The lecture includes a sum up of the document produced after the world renowned experts scientific gathering of the v-WINter international meeting, held in Cortina (Italy) on

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“…Even though PTS guidelines do not support the use of ECS for PTS prevention, they suggest the use of ECS for management of acute DVT symptoms [15]. Regarding prevention of PTS, a substudy of the IDEAL-DVT study showed that patients who were randomized in centers that applied ECS early, or within 24 h of diagnosis, had a lower risk of residual venous obstruction [66], and those with reduced residual venous obstruction had a lower risk of PTS. However, groups were not well balanced, with more femoral-popliteal than common femoral DVTs in the early compression group.…”

Section: When Should Ecs Be Applied?mentioning

confidence: 99%

Prevention and Management of the Post-Thrombotic Syndrome

Makedonov

Kahn

Galanaud

2020

JCM

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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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Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis

Abstract: Key Points Immediate compression therapy after DVT is associated with a 20% absolute reduction of RVO. The reduction of residual thrombosis is associated with an 8% absolute reduction of postthrombotic syndrome at 24 months.

Cited by 48 publications

References 37 publications

Deep vein thrombosis: update on diagnosis and management

Deep vein thrombosis: update on diagnosis and management

抄録1・2日目

Prevention and Management of the Post-Thrombotic Syndrome

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