Rutosides for treatment of post-thrombotic syndrome

Morling, Joanne R; Broderick, Cathryn; Yeoh, Su Ern; Kolbach, Dinanda N

doi:10.1002/14651858.cd005625.pub4

Cited by 17 publications

(17 citation statements)

References 18 publications

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“…Anticoagulation does not prevent PTS . Thrombolysis relieves venous outflow obstruction and has been used to prevent PTS in extensive DVT, although clinical trial results have been mixed .…”

Section: Complications Of Venous Thromboembolismmentioning

confidence: 99%

New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism

Tran

Gibbs

Merriman

et al. 2019

Medical Journal of Australia

107

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Introduction Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease and, globally, more than an estimated 10 million people have it yearly. It is a chronic and recurrent disease. The symptoms of VTE are non‐specific and the diagnosis should actively be sought once considered. The mainstay of VTE treatment is anticoagulation, with few patients requiring additional intervention. A working group of experts in the area recently completed an evidence‐based guideline for the diagnosis and management of DVT and PE on behalf of the Thrombosis and Haemostasis Society of Australia and New Zealand (http://www.thanz.org.au/resources/thanz-guidelines). Main recommendations The diagnosis of VTE should be established with imaging; it may be excluded by the use of clinical prediction rules combined with D‐dimer testing. Proximal DVT or PE caused by a major surgery or trauma that is no longer present should be treated with anticoagulant therapy for 3 months. Proximal DVT or PE that is unprovoked or associated with a transient risk factor (non‐surgical) should be treated with anticoagulant therapy for 3–6 months. Proximal DVT or PE that is recurrent (two or more) and provoked by active cancer or antiphospholipid syndrome should receive extended anticoagulation. Distal DVT caused by a major provoking factor that is no longer present should be treated with anticoagulant therapy for 6 weeks. For patients continuing with extended anticoagulant therapy, either therapeutic or low dose direct oral anticoagulants can be prescribed and is preferred over warfarin in the absence of contraindications. Routine thrombophilia testing is not indicated. Thrombolysis or a suitable alternative is indicated for massive (haemodynamically unstable) PE. Changes in management as a result of the guideline Most patients with acute VTE should be treated with a factor Xa inhibitor and be assessed for extended anticoagulation.

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Section: Complications Of Venous Thromboembolismmentioning

confidence: 99%

New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism

Tran

Gibbs

Merriman

et al. 2019

Medical Journal of Australia

107

View full text Add to dashboard Cite

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“…The limitations of these trials include small sample size (ranging from 29 to 288), short treatment period (ranging from 8 weeks to 12 months), lack of a washout period (in the single crossover trial), lack of reporting on adverse events (in one trial), questionable clinical utility of the outcome measures (calf and ankle circumference in one trial) and lack of adequate blinding (some deficiency in all four trials). As such, meta-analyses have judged the evidence to be of low quality [102,103]. The most recent Cochrane meta-analysis found no evidence to conclude that rutosides are superior to placebo or ECS [102].…”

Section: What Medical Measures Should Be Used For Treatment Of Pts?mentioning

confidence: 99%

“…As such, meta-analyses have judged the evidence to be of low quality [102,103]. The most recent Cochrane meta-analysis found no evidence to conclude that rutosides are superior to placebo or ECS [102]. Another meta-analysis concluded that there was only limited evidence in support of venoactive medications for treatment of PTS [103].…”

Section: What Medical Measures Should Be Used For Treatment Of Pts?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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“…Complex lymphedema therapy on top of elastic compression therapy was only superior in patients with severe PTS while other studies such as the veno‐wave study were solely directed at patients with severe PTS . 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: Barriers To Progress and Future Perspectivesmentioning

confidence: 99%

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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Rutosides for treatment of post-thrombotic syndrome

Abstract: Analysis 3.2. Comparison 3 Rutosides versus hidrosmina for the treatment of PTS, Outcome 2 Deterioration in PTS.

Cited by 17 publications

References 18 publications

New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism

New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism

Prevention and Management of the Post-Thrombotic Syndrome

Prevention and treatment of the post‐thrombotic syndrome

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