Stockings to prevent post-thrombotic syndrome

Cate‐Hoek, Arina J. ten

doi:10.1136/bmj.i2897

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…3–5 Still some authors emphasize the value of consequent compression therapy in selected patients to prevent PTS. 6,7 However, this therapy offers no direct thrombolytic effect and the recanalization of the involved veins and the preservation of valve function depend on the individual fribinolytic system. The PTS as the long-term sequela of DVT is caused by venous obstruction or insufficiency of the deep venous system.…”

Section: Introductionmentioning

confidence: 99%

Patency rate and quality of life after ultrasound-accelerated catheter-directed thrombolysis for deep vein thrombosis

Gombert

Gombert²,

Barbati

et al. 2017

Phlebology

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Purpose Studies on ultrasound-accelerated, catheter-directed thrombolysis of acute deep vein thrombosis emphasize good patency rates and low complication rates. Therefore, we analyzed quality of life besides technical success and patency in our patients after ultrasound-accelerated, catheter-directed thrombolysis. Methods Between 2009 and 2014, 42 patients suffering from iliofemoral deep vein thrombosis received ultrasound-accelerated, catheter-directed thrombolysis. Follow-up included clinical exanimation and ultrasound. Thirty patients (36 interventions), mean age 41.3 years (range 19-71 years), 56.6% women (17/30), completed the surveys. Five different scores were used to assess the quality of life and symptoms of postthrombotic syndrome: SF36, Euro-QOL 5D, PDI, VEINES-QOL/Sym, and the Villalta score. Results Mean therapy duration of ultrasound-accelerated, catheter-directed thrombolysis was 76.4 h and therapeutic success could be reported in 80.5% (29/36). Successful ultrasound-accelerated, catheter-directed thrombolysis was followed by stent angioplasty in 58.3% (21/36) procedures. Overall complication rate was 19.44%, mainly formed by minor bleedings. Mean follow-up was 38.5 months. The primary patency rate was 63.8%, the assisted-primary and the secondary patency rate were 80.5%. We observed an improved quality of life in our patients' cohort compared to patients suffering from postthrombotic syndrome. Conclusion Although ultrasound-accelerated, catheter-directed thrombolysis is feasible with good patency rates, further prospective randomized trials are necessary to evaluate the value of thrombus removal in iliofemoral deep vein thrombosis in comparison to conservative treatment.

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Section: Introductionmentioning

confidence: 99%

Patency rate and quality of life after ultrasound-accelerated catheter-directed thrombolysis for deep vein thrombosis

Gombert

Gombert²,

Barbati

et al. 2017

Phlebology

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“…This trial investigated whether the main therapeutic effect of individualized ECS therapy following initial 6 months of ECS therapy would not be unacceptably different from that of standard duration of therapy, and whether the accepted loss of efficacy of the new therapy would be balanced by a reduction in costs and or an increase in HRQoL. 41 The upper margin of the loss of efficacy that was deemed to be acceptable was set at 7.5% (the noninferiority margin). 42…”

Section: Individualized Duration Of Ecs Treatmentmentioning

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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“…Subsequently, the venous flow accelerates and the venous ejection fraction improves. 12 Venous flow has shown to influence the process of thrombus resolution; animal experimental studies show that reduced flow is associated with pronounced inflammatory reactions and causes excess remodeling of the vein wall and poor thrombus resolution. 13 On the other hand improving venous flow diminished the inflammatory reactions.…”

Section: The Mechanistic Substrate For the Effectiveness Of Compressimentioning

confidence: 99%

Compression to prevent PTS: a controversy?

2016

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Compression therapy, prescribed as elastic compression stockings, is the cornerstone in the management of post-thrombotic syndrome. The effectiveness of elastic compression stockings has recently been called into question in a large randomized placebo-controlled trial. The findings however may be less contradictory than assumed and presented. The mechanistic substrate for the effectiveness of compression therapy is based on its ability to counteract venous hypertension, which is a central aspect in the pathophysiology of post-thrombotic syndrome. Nevertheless, despite elastic compression stockings a significant percentage (20-50%) of patients develops post-thrombotic syndrome, suggesting that there are other factors to be considered next to compression. Every patient has an individual baseline risk value, constituted of non-modifiable and modifiable risk factors (i.e. age, sex, bodyweight etcetera). Straining patients at risk is therefore crucial. Exploring additional or alternative forms of therapy is desirable as well since these are in addition to the risk factors, costs aspects and quality of life, puzzle pieces in the management of post-thrombotic syndrome, which once pieced together enables multifactorial yet individualized therapy.

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Stockings to prevent post-thrombotic syndrome

Cited by 4 publications

References 8 publications

Patency rate and quality of life after ultrasound-accelerated catheter-directed thrombolysis for deep vein thrombosis

Patency rate and quality of life after ultrasound-accelerated catheter-directed thrombolysis for deep vein thrombosis

Prevention and treatment of the post‐thrombotic syndrome

Compression to prevent PTS: a controversy?

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