scholarly journals Gaps arising from randomized controlled trials on thrombolysis for proximal deep vein thrombosis of the lower limb

2022 ◽  
Vol 10 (1) ◽  
pp. 196-199.e2
Author(s):  
Petroula Nana ◽  
Efthymios Avgerinos ◽  
Konstantinos Spanos ◽  
Athanasios Giannoukas ◽  
Nicos Labropoulos
Keyword(s):  
Deep Vein Thrombosis ◽  
Randomized Controlled Trials ◽  
Lower Limb ◽  
Proximal Deep Vein Thrombosis ◽  
Controlled Trials ◽  
Vein Thrombosis ◽  
Randomized Controlled ◽  
Deep Vein

Does prescription of medical compression prevent development of post-thrombotic syndrome after proximal deep venous thrombosis?

2015 ◽  
Vol 31 (3) ◽  
pp. 160-169 ◽  
Author(s):  
Michel Perrin ◽  
Bo Eklöf
Keyword(s):  
Deep Vein Thrombosis ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Compression Stockings ◽  
Elastic Compression ◽  
Vein Thrombosis ◽  
Randomized Controlled ◽  
Post Thrombotic Syndrome ◽  
Deep Vein

Aim The aim of this review is to try to explain the controversy by critical analysis of previously published randomized controlled trials on the value of elastic compression stockings in the treatment of acute proximal deep vein thrombosis in prevention of post-thrombotic syndrome, which forms the scientific basis for our present management. Methods A research was made through Medline and Embase databases to identify relevant original articles, not abstracts, with the following keywords: post-thrombotic syndrome, deep venous thrombosis, venous thromboembolism, compression stockings, prevention and compliance. Results We identified five randomized controlled trials (RCTs) before the SOX trial including 798 patients with acute proximal deep vein thrombosis. Brandjes (1997): at two years’ follow-up, elastic compression stockings reduced post-thrombotic syndrome by 50%; Ginsberg (2001): no difference in post-thrombotic syndrome with or without elastic compression stockings after more than two years’ follow-up; Partsch (2004): elastic compression stockings with routine above knee and early ambulation reduced the incidence and severity of post-thrombotic syndrome after two years’ follow-up; Prandoni (2004) showed significantly less post-thrombotic syndrome after elastic compression stockings for two years with a five-year follow-up; Aschwanden (2008) showed no difference with elastic compression stockings after three years’ follow-up. Conclusion Prescription of elastic compression stockings for the prevention of post-thrombotic syndrome is now in doubt. Immediate compression after diagnosis of acute deep vein thrombosis to prevent swelling and reduce pain, permitting early ambulation in combination with adequate anticoagulation has proven benefit, although a secondary analysis of the SOX trial refutes this belief. Continued long-term compression treatment is questioned. Two major questions remain: Is the lack of positive outcome on the development of post-thrombotic syndrome after proximal deep vein thrombosis due to the fact that there were a few patients with iliofemoral extension in the quoted randomized controlled trials who may benefit from prolonged medical compression treatment? Compliance is the major issue, and the two randomized controlled trials with excellent control of compliance showed significant reduction in the rate of post-thrombotic syndrome, but we know that in daily practice the adherence is closer to Kahn’s data.

scholarly journals The efficiency and safety of recombinant factor VIIa for bleeding in patients without haemophilia: a meta-analysis of 12 randomized controlled trials

2020 ◽  
Author(s):  
Ying Zhang ◽  
Yuting Wang ◽  
Youfa Zhou ◽  
Jian Li ◽  
Haiyan Zhou
Keyword(s):  
Randomized Controlled Trials ◽  
Recombinant Factor Viia ◽  
Factor Viia ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Vein Thrombosis ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Deep Vein

Abstract Background: Despite widely use of recombinant factor VIIa (rFVIIa) for bleeding in patients without haemophilia, its efficiency and safety remain unclear. Therefore, we carried out a meta-analysis on this topic. Methods: We searched Cochrane Library, Web of Science, PubMed and Embase, from January 2008 to July 2019 for randomized controlled trials on the topic. The results of this work are synthesized and reported in accordance with the PRISMA statement. Results: Twelve trials met our inclusion criteria. rFVIIa over 200ug/kg reduced red blood cell (RBC) transfusions within 24 h by 232.34ml (95% confidence interval [CI]; -410.31 to -54.37). rFVIIa did not significantly reduce 30-day mortality (relative risk [RR], 1.00; 95%CI, 0.82-1.21), total thromboembolic events (RR, 1.13; 95%CI, 0.94-1.36), myocardial infarction (RR, 1.37; 95%CI, 0.92-2.05), deep vein thrombosis (RR, 0.83; 95%CI, 0.52–1.33), ICU staying (RR, 0.40; 95%CI, -1.28 to 2.07) and number of patients transfused RBC (RR, 0.94; 95%CI, 0.83-1.08). However, rFVIIa may increase the incidence of arterial thrombotic events (RR, 1.38; 95%CI, 1.08–1.77). Conclusion: rFVIIa over 200ug/kg reduced RBC transfusions for bleeding in patients without haemophilia. However, it may increase the risk of arterial thrombotic events.

Proximal deep vein thrombosis of the lower limb extended to the inferior vena cava in a child

2016 ◽  
Vol 28 (1) ◽  
pp. 30-32
Author(s):  
Lova Hasina Rajaonarison Ny Ony Narindra ◽  
Tojo Rafaralahivoavy ◽  
Anja Randriamarolahy ◽  
Anna Bjorkman ◽  
Ahmad Ahmad ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Inferior Vena Cava ◽  
Lower Limb ◽  
Inferior Vena ◽  
Vena Cava ◽  
Proximal Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Deep Vein

Timing and duration of compression therapy after deep vein thrombosis

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 78-82 ◽  
Author(s):  
AC Bouman ◽  
AJ ten Cate-Hoek
Keyword(s):  
Deep Vein Thrombosis ◽  
Preventive Measure ◽  
Compression Therapy ◽  
Controlled Trials ◽  
Compression Stockings ◽  
Vein Thrombosis ◽  
Randomized Controlled ◽  
Optimal Duration ◽  
Deep Vein

After deep vein thrombosis (DVT) 20-50%, of patients develop post thrombotic syndrome (PTS). Up till now, there is no effective treatment for PTS and prevention is therefore of major importance. Compression therapy after DVT, with elastic compression stockings (ECS), is the only available preventive measure for PTS. However, the usefulness, timing, and duration of compression therapy are matters of debate. The effect of early compression on the long-term development of PTS is still unclear as studies performed so far have conflicting outcomes.16–19 The effectiveness of ECS therapy initiated in the sub-acute phase was assessed in three large randomized controlled trials. Kahn et al could not reproduce the large risk reduction found in the trials by Brandjes and Prandoni et al.20–22 Also for the optimal duration of ECS therapy, a certain conclusion has yet to be drawn. Therefore identification of patients who most likely will benefit from ECS therapy as well as the optimal ECS treatment strategy remain subjects for further study.

Acute Deep Vein Thrombosis Treated with Porcine Plasmin

1974 ◽  
Vol 32 (02/03) ◽  
pp. 468-482 ◽  
Author(s):  
O Storm ◽  
P Ollendorff ◽  
E Drewsen ◽  
P Tang
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Initial Dose ◽  
Treated Group ◽  
Allergic Reactions ◽  
Double Blind ◽  
Vein Thrombosis ◽  
Thrombolytic Effect ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

SummaryThe thrombolytic effect of pig plasmin was tested in a double blind trial on patients with deep venous thrombosis in the lower limb. Only patients with not more than three days old thrombi were selected for this study. The diagnosis of deep vein thrombosis was made clinically and confirmed by phlebography. Lysofibrin Novo (porcine plasmin) or placebo (porcine plasminogen) was administered intravenously to the patients. The enzyme and the placebo were delivered as lyophilized powder in labelled bottles - the contents of the bottles were unknown to the doctor in charge of the clinical administration of the trial. An initial dose of plasmin/plasminogen of 30 unit per kg body weight given slowly intravenously (1-1% hours infusion) was followed by a maintenance dosis of 15 per cent the initial dose per hour for the following 5-7 hours. In most cases a similar maintenance dosis was given the next day. In all patients heparin was administered after ending the plasmin/plasminogen infusion. The results of the treatment was evaluated clinically as well as by control phlebo- grams the following days.A statistically significant improvement was found in the plasmin treated group compared with the placebo (plasminogen) treated group. Thrombolysis was obtained clinically and phlebographically in 65 per cent of the plasmin treated group, but only in 15 per cent of the control patients were improvements found.This study has thus demonstrated that plasmin treatment according to a standard scheme was able to induce thrombolysis. There were only a few and insignificant side effects. Allergic reactions have not been seen and only very simple tests are required.

Controlled Trial of the Sequential Use of Streptokinase and Ancrod in the Treatment of Deep Vein Thrombosis of Lower Limb

1977 ◽  
Vol 37 (02) ◽  
pp. 222-232 ◽  
Author(s):  
D. A Tibbutt ◽  
C. N Chesterman ◽  
E. W Williams ◽  
T Faulkner ◽  
A. A Sharp
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Improvement ◽  
Anticoagulant Therapy ◽  
Lower Limb ◽  
Oral Anticoagulant ◽  
Controlled Trial ◽  
Oral Anticoagulant Therapy ◽  
Control Group ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryTreatment with streptokinase (‘Kabikinase’) was given to 26 patients with venographically confirmed deep vein thrombosis extending into the popliteal vein or above. Treatment was continued for 4 days and the patients were allocated randomly to oral anticoagulant therapy or a course of treatment with ancrod (‘Arvin’) for 6 days followed by oral anticoagulant therapy. The degree of thrombolysis as judged by further venographic examination at 10 days was not significantly different between the 2 groups. The majority of patients showed clinical improvement but there was no appreciable difference between the groups at 3 and 6 months. Haemorrhagic complications were a more serious problem during the period of treatment with ancrod than during the equivalent period in the control group.

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