Home Therapy of Venous Thrombosis with Long-term LMWH versus Usual Care: Patient Satisfaction and Post-thrombotic Syndrome

2009 ◽  
Vol 122 (8) ◽  
pp. 762-769.e3 ◽  
Author(s):  
Russell D. Hull ◽  
Graham F. Pineo ◽  
Rollin Brant ◽  
Jane Liang ◽  
Roy Cook ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Venous Thrombosis ◽  
Usual Care ◽  
Care Patient ◽  
Home Therapy ◽  
Post Thrombotic Syndrome

Incidence, Timing of Onset and Severity of Post-Thrombotic Syndrome after Acute Symptomatic Deep Vein Thrombosis: Two-Year Results from a Canadian Multicenter Prospective Cohort Study (The VETO Study).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1636-1636
Author(s):  
Susan R. Kahn ◽  
Thierry Ducruet ◽  
Louise Arsenault ◽  
Marie Jose Miron ◽  
Andre Roussin ◽  
...  
Keyword(s):  
Longitudinal Data ◽  
Venous Thrombosis ◽  
Late Onset ◽  
Cumulative Probability ◽  
Study Cohort ◽  
Post Thrombotic Syndrome ◽  
Kaplan Meier ◽  
Timing Of Onset

Abstract Background and Objectives: The post thrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT). It is difficult to provide DVT patients with long-term prognostic information as there is little longitudinal data on the occurrence of PTS after DVT. We performed a prospective multicenter study of long-term outcomes after DVT (the Venous Thrombosis Outcomes [VETO] Study) to determine the incidence, timing of onset and severity of PTS. Methods: Consecutive patients with objectively diagnosed acute DVT were recruited at 7 participating hospital centres from April 2001-July 2002. Patients attended study visits at Baseline, 4, 8, 12 and 24 months. Clinical data were recorded and standardized assessments for PTS (using Villalta scale) were performed by trained study personnel at each follow-up visit. Patients were classified as having developed PTS if the ipsilateral Villalta score was ≥ 5 on at least 2 visits or at the final follow-up visit, and having severe PTS if a score of >14 or a venous ulcer was documented on any one occasion. The Kaplan-Meier survival method was used to estimate the cumulative probability of PTS and of severe PTS over time. Results: The study cohort consisted of 359 patients. The mean age was 56 years, 50% were male, 2/3 were outpatients, 55% had proximal DVT and 20% had previous DVT. The Kaplan-Meier estimates of cumulative risk of PTS were 29% at 4 months, 33% at 8 months, 35% at 12 months and 37% at 24 months. Corresponding risks of severe PTS were 6.6%, 6.9%, 6.9% and 6.9%, respectively. When the analysis was stratified according to history of DVT, the cumulative incidence of PTS in patients without previous DVT was 25%, 28%, 30% and 31% at 4, 8, 12 and 24 months. Corresponding rates of PTS in patients with previous DVT were 45%, 51%, 53% and 57%. Conclusions: More than one third of patients in our cohort developed PTS within 2 years of DVT, and of these, 1 in 6 was classified as severe. Most cases of PTS and of severe PTS were apparent by 4 months after DVT. Patients with previous DVT had a higher frequency of PTS and of late onset PTS. Our study provides longitudinal data on prognosis that is relevant both to patients with DVT and their treating physicians.

scholarly journals The Burden of Post-Thrombotic Syndrome in a Long-Term Retrospective Cohort in Northern Portugal

2020 ◽  
Vol 33 (13) ◽  
Author(s):  
Inês Mendes-Andrade ◽  
Marina Dias-Neto ◽  
João Rocha-Neves ◽  
Armando Mansilha
Keyword(s):  
Quality Of Life ◽  
Relative Risk ◽  
Confidence Interval ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Retrospective Cohort ◽  
Post Thrombotic Syndrome ◽  
Northern Portugal

Introduction: Post-thrombotic syndrome is a frequent and disabling complication of deep venous thrombosis. Its incidence is not described in the Portuguese population. The objective of this study is to report the incidence and severity of post-thrombotic syndrome after the initial episode of deep venous thrombosis.Material and Methods: This is an observational, unicentric, retrospective cohort of patients who had a first episode of deep venous thrombosis in the lower limb, documented with duplex ultrasound (n = 101). The modified Villalta score was applied by phone interview for the diagnosis and staging of post-thrombotic syndrome. The quality of life of patients was measured with the modified CIVIQ 14 classification.Results: Median follow-up time was six years (interquartile range 1). Severe post-thrombotic syndrome was present in 27% of patients and moderate in 33%. Performing physical activity at the time of the interview was associated with lower incidence of post-thrombotic syndrome (relative risk 0.489; 95% confidence interval = 0.320 - 0.748). Body weight gain after deep venous thrombosis (relative risk 2.188; 95% confidence interval 1.137 - 4.210) and lower education levels (relative risk 2.005; 95% confidence interval 1.297 - 3.098) were associated positively with post-thrombotic syndrome. Quality of life was 90 ± 17 vs 64 ± 18 vs 43 ± 15 in patients without postthrombotic syndrome, with moderate post-thrombotic syndrome and with severe post-thrombotic syndrome, respectively (p < 0.001).Discussion: The long-term incidence of post-thrombotic syndrome in a cohort of patients from Northern Portugal is higher than in other studies and correlates with worse adjusted CIVIQ-14 scores.Conclusion: Large studies of prospective nature could provide more definitive evidence.

Long term efficacy of mobilisation with movement on pain and functional status in patients with knee osteoarthritis: a randomised clinical trial

2020 ◽  
pp. 026921552094693
Author(s):  
Aishwarya Nigam ◽  
Kiran H Satpute ◽  
Toby M Hall
Keyword(s):  
Patient Satisfaction ◽  
Confidence Interval ◽  
Knee Osteoarthritis ◽  
Usual Care ◽  
Primary Outcome ◽  
Mean Difference ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

Objectives: To evaluate the long term effect of mobilisation with movement on disability, pain and function in subjects with symptomatic knee osteoarthritis Design: A randomised controlled trial. Setting: A general hospital Subjects: Forty adults with knee osteoarthritis (grade 1–3 Kellgren–Lawrence scale). Interventions: The experimental group received mobilisation with movement and usual care (exercise and moist heat) while the control group received usual care alone in six sessions over two weeks. Main Measures: The primary outcome was the Western Ontario McMaster University Osteoarthritis index, higher scores indicating greater disability. Pain intensity over 24 hours and during sit to stand were measured on a 10 centimetre visual analogue scale. Functional outcomes were the timed up and go test, the 12 step stair test, and knee range of motion. Patient satisfaction was measured on an 11 point numerical rating scale. Variables were evaluated blind pre- and post intervention, and at three and six months follow-up. Results: Thirty five participants completed the study. At each follow-up including six-months, significant differences were found between groups favouring those receiving mobilisation with movement for all variables except knee mobility. The primary outcome disability showed a mean difference of 7.4 points (95% confidence interval, 4.5 to 10.3) at six-months and a mean difference of 13.6 points (95% confidence interval, 9.3 to 17.9) at three-months follow-up. Conclusion: In patients with symptomatic knee osteoarthritis, the addition of mobilisation with movement provided clinically significant improvements in disability, pain, functional activities and patient satisfaction six months later.

The Future of Deep Venous Thrombosis and Post-thrombotic Syndrome in 2020

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 95-102 ◽  
Author(s):  
A J Comerota
Keyword(s):  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Imaging Techniques ◽  
Vena Cava ◽  
Pharmacological Therapy ◽  
Long Term Results ◽  
Post Thrombotic Syndrome ◽  
Vena Cava Filters

This manuscript addresses six major issues involving deep venous thrombosis (DVT) and post-thrombotic syndrome. Prevention will likely see modest advances in pharmacological therapy mainly by extending prophylaxis in high-risk patients. More notable advances will be observed in mechanical means of prophylaxis, focusing on sustained application of devices that can move larger volumes of blood. Silent, large-vein thrombi continue to place patients at risk for fatal pulmonary embolism. Improved imaging techniques will permit us to identify these patients over the next eight years. In many of those patients, vena caval interruption will be required. Elimination of high-risk filters and the production of improved filters placed through low-profile systems with antithrombotic agents bound to their surface will improve the short- and long-term results for inferior vena cava filters. The long-term management of DVT will focus on establishing appropriate duration for the individual patient and will see the evolution towards direct Xa and Ha inhibitors. Patients with extensive DVT will more commonly receive treatment strategies designed to eliminate thrombus and restore patency. This will substantially reduce post-thrombotic morbidity and reduce recurrence. Post-thrombotic syndrome will see greater attention towards treating the intraluminal fibrosis, thereby eliminating post-thrombotic venous obstruction. Unfortunately, neovalves will still be searching for the appropriate application.

Long-term increased factor VIII levels are associated to interleukin-6 levels but not to post-thrombotic syndrome in patients with deep venous thrombosis

2015 ◽  
Vol 135 (3) ◽  
pp. 497-501 ◽  
Author(s):  
Luis Fernando Bittar ◽  
Bruna de Moraes Mazetto ◽  
Fernanda L. Andrade Orsi ◽  
Marina P. Collela ◽  
Erich Vinícius De Paula ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Factor Viii ◽  
Deep Venous Thrombosis ◽  
Interleukin 6 ◽  
Post Thrombotic Syndrome

Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis

VASA ◽  
2016 ◽  
Vol 45 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Jakob Martin Burgstaller ◽  
Johann Steurer ◽  
Ulrike Held ◽  
Beatrice Amann-Vesti
Keyword(s):  
Systematic Review ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Cochrane Library ◽  
Compression Stockings ◽  
Post Thrombotic Syndrome ◽  
Study Results ◽  
Preventive Efficacy ◽  
One Year ◽  
The Cochrane Library

Abstract. Background: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. Methods: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. Results: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. Conclusions: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.

Idiopathic venous thrombosis

2006 ◽  
Vol 26 (01) ◽  
pp. 52-54 ◽  
Author(s):  
P. A. Kyrle
Keyword(s):  
Chronic Disease ◽  
Venous Thrombosis ◽  
Vitamin K ◽  
Clinical Benefit ◽  
Plasma Levels ◽  
Vitamin K Antagonists ◽  
Antithrombin Deficiency ◽  
Optimal Duration ◽  
Risk Of Treatment

SummaryVenous thrombosis is a chronic disease with a recurrence rate of approximately 30% within 5-8 years. The optimal duration of secondary thromboprophylaxis in these patients entails balancing the risk of recurrence against the risk of treatment-associated bleeding. There is agreement that patients with a first idiopathic venous thrombosis should receive vitamin K antagonists for at least 3-6 months. Convincing trials showing a clinical benefit in terms of morbidity or mortality with respect to expansion of anticoagulation beyond 6 months are lacking. Nevertheless, some subgroups of patients with venous thrombosis may benefit from indefinite anticoagulation. Thus, patients with antithrombin deficiency, combined or homozygous defects, more than one unprovoked episode of thrombosis, the lupus anticoagulant or high factor VIII plasma levels are good candidates for long-term prevention.

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