Pharmacomechanical catheter thrombolysis for pregnancy-related proximal deep venous thrombosis: prevention of post-thrombotic syndrome

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.

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Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2021.06.023 ◽

2021 ◽

Author(s):

Xinrui Yang ◽

Xing Zhang ◽

Minyi Yin ◽

Ruihua Wang ◽

Xinwu Lu ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Compression Stockings ◽

Elastic Compression ◽

Post Thrombotic Syndrome ◽

Thrombus Removal

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Below knee elastic compression stockings reduced development of the post-thrombotic syndrome in proximal deep venous thrombosis

Evidence-Based Medicine ◽

10.1136/ebm.10.1.22 ◽

2005 ◽

Vol 10 (1) ◽

pp. 22-22 ◽

Cited By ~ 1

Author(s):

D. A Garcia

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Compression Stockings ◽

Elastic Compression ◽

Post Thrombotic Syndrome

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Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.006817 ◽

2017 ◽

Vol 16 (4) ◽

pp. 304-307

Author(s):

Eduardo Simões Da Matta

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Plantar Flexion ◽

Compression Therapy ◽

Stiffness Index ◽

Postthrombotic Syndrome ◽

Static Stiffness ◽

Valve Mechanism ◽

Muscle Strengthening ◽

Post Thrombotic Syndrome

Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the “valve mechanism” generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

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Long-term Clinical Follow-up in 265 Patients with Deep Venous Thrombosis Initially Treated with either Unfractionated Heparin or Dalteparin: A Retrospective Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614364 ◽

1999 ◽

Vol 82 (10) ◽

pp. 1222-1226 ◽

Cited By ~ 16

Author(s):

W. Åberg ◽

D. Lockner ◽

C. Paul ◽

M. Holmström

Keyword(s):

Risk Factor ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Unfractionated Heparin ◽

Malignant Disease ◽

Duration Of Treatment ◽

Post Thrombotic Syndrome ◽

Recurrent Vte

SummaryThe primary objective of this retrospective study was to describe the frequency of a post-thrombotic syndrome in 265 patients previously treated for deep venous thrombosis (DVT). The secondary objectives were to document the frequency of recurrent venous thromboembolism (VTE) and mortality, especially from malignant disease. The patients were evaluated 5-14 years after inclusion in three randomized trials comparing continuous intravenous (i. v.) infusion of unfractionated heparin (UFH) (n = 85) with a low molecular weight heparin (LMWH), dalteparin (n = 180). The median post-thrombotic score at follow-up was 2 (range 0-8). In a multiple step-wise regression analysis the post-thrombotic score was significantly higher among patients with initial proximal DVT (p = 0,0001) as compared with those who had distal DVT. A recurrent venous thromboembolic event was diagnosed in 29,4% of the patients treated with dalteparin and in 23,5% of the patients treated with UFH (ns). A secondary risk factor for venous thromboembolism and a longer duration of treatment with oral anticoagulants (OAC) were significantly associated with a lower risk for recurrent VTE, whereas malignant disease diagnosed during follow-up was associated with a higher risk. During follow-up a total of 40,7% of patients had died. No difference in total mortality or mortality from malignant disease was demonstrated between the two drugs. In conclusion, a severe post-thrombotic syndrome occured relatively infrequent. considering the long observation period. Proximal DVT was significantly associated with a more severe post-thrombotic syndrome. After 14 years follow-up, no significant differences were observed in overall mortality, mortality from malignant disease or recurrent VTE between UFH- and dalteparin-treated patients. Malignant disease was a risk factor for recurrent VTE, the presence of a secondary risk factor and a longer duration of treatment with OAC decreased the risk for recurrent VTE.

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Validation of the LET classification

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515569133 ◽

2015 ◽

Vol 30 (1_suppl) ◽

pp. 14-19 ◽

Cited By ~ 19

Author(s):

RHW Strijkers ◽

CWKP Arnoldussen ◽

CHA Wittens

Keyword(s):

Quality Of Life ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Odds Ratio ◽

Original Data ◽

Self Assessment ◽

Post Thrombotic Syndrome ◽

Thrombus Removal ◽

Disease Specific

Introduction Acute thrombus removal therapies may reduce post-thrombotic syndrome in certain deep venous thrombosis patients. The LET classification is designed to identify patients at high risk for developing post-thrombotic syndrome in the acute phase using thrombus location and extent. This study evaluates the use of the LET classification to predict post-thrombotic syndrome in a cohort of patients after deep venous thrombosis. Methods A cohort of 660 deep venous thrombosis patients was invited to participate and fill out a questionnaire with Quality of life questionnaires, basic information, a modified self-assessment version of the Villalta scale for post-thrombotic syndrome and potential confounders. Original data on thrombus extension was available, and the LET classes were determined. Obtained information was analysed using ANOVA and in a multiple logistic regression model to correct for confounders. All different LET classes were compared to post-thrombotic syndrome occurrence, post-thrombotic syndrome prediction and disease specific quality of life scores (VEINES-Sym/Qol). Results Three hundred and fifteen patients responded, and in 309 a post-thrombotic syndrome score was distilled. LET I,II,III ( n = 63) had an odds ratio of 3.4(1.2–9.2) for predicting severe post-thrombotic syndrome, and LET II ( n = 17) had an odds ratio of 5.1(1.3–20.8) compared to LET class I ( n = 97). Both the VEINES-Sym and VEINES-Qol score were significantly lower for LET I,II,III compared to LET I, and LET II compared to LET I. Conclusion The LET classification can be used to classify patients according to acute thrombus location and extent. Extensive and centrally located (LET I,II,III) deep venous thrombosis showed the highest probability in developing severe post-thrombotic syndrome and lower disease specific quality of life.

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Initial experience with a new pharmacomechanical thrombectomy device for deep venous thrombosis: Report of 91 cases

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519833235 ◽

2019 ◽

Vol 34 (10) ◽

pp. 707-714

Author(s):

Şahin Bozok ◽

Kaptanıderya Tayfur

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Color Doppler ◽

Early Period ◽

Efficacy And Safety ◽

Duration Of Symptoms ◽

Post Thrombotic Syndrome ◽

Tertiary Center ◽

Patient Reported ◽

Thrombectomy Device

Background To evaluate the efficacy and safety of pharmacomechanical thrombectomy using a new rotational thrombectomy device with additional thrombus-removal methods for deep venous thrombosis. Methods A total of 91 patients admitted to our tertiary center with symptomatic iliac, ilio-femoral, femoro-popliteal deep venous thrombosis and who underwent hybrid pharmacomechanical thrombectomy constituted the study group. Postinterventional color Doppler ultrasonography was repeated at 1st, 6th, and 12th months. Villalta scoring system was used to evaluate the patients for the development of post-thrombotic syndrome after deep venous thrombosis. The patient-reported severity of pain in the index leg was measured on a Likert scale. Results Of the 91 patients whose charts were reviewed, the location of thrombus was iliofemoral in 60 (65.9%) and femoropopliteal in 31 (34.1%) patients, respectively. Duration of symptoms was 5.62 ± 3.43 (range, 2–15) days. Technical success was observed in 82 patients (90.1%) at 3 months, in 77 patients (84.6%) at 6 months, and in 74 patients (81.3%) at 12 months. Villalta score was over 10 points in 15 of 17 patients whose Doppler US revealed venous occlusions, at 12 months, and in 8 patients with recurrent deep venous thrombosis. Post-thrombotic syndrome was detected in 18 patients in our study. Twelve (13.2%) of these 18 patients had mild, 5 (5.5%) moderate, and 1 (1.1%) severe PTS. In predicting predisposing factors in 18 patients with PTS, 13 patients (72.2%) had a Villalta score ≥10, 10 patients (55.6%) had experienced a delayed endovascular procedure (≥10 days), and 8 patients (44.4%) had recurrent deep venous thrombosis. Conclusion The endovenous pharmacomechanical thrombectomy with the Mantis thrombectomy device in the treatment of acute and subacute iliofemoral deep venous thrombosis is a promising approach in terms of efficacy and safety in the early period regarding reasonable and long-term prevention of post-thrombotic syndrome, development of pulmonary thromboembolism, and adequate venous system patency.

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