Sclerotherapy is a safe method of treatment of chronic venous disorders in older patients: A prospective and comparative study of consecutive patients

2016 ◽  
Vol 32 (4) ◽  
pp. 234-240 ◽  
Author(s):  
Jean-Luc Gillet ◽  
Claudine H Desnos ◽  
Michel Lausecker ◽  
Christian Daniel ◽  
Jean-Jerome Guex ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Comparative Study ◽  
Older Patients ◽  
Medial Gastrocnemius ◽  
Vein Thrombosis ◽  
Superficial Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Objectives An aging population requires evaluation of methods of treatment for older patients. Our objective was to evaluate the indications, practical modalities, safety and tolerability of sclerotherapy in patients 75 years of age and older (group 1) and compare with a control group of patients 18 to74 years of age (group 2). Method This observational, multicentre, prospective and comparative study was conducted by the French Society of Phlebology. Each centre collected in 10 to 20 patients ≥75 years of age and an equal number of patients <75 years of age treated by sclerotherapy, the treatment indication, the patient's personal history, the CEAP clinical class, the type of the veins being treated, the characteristics of sclerotherapy and the complications (immediately after treatment and at one-month follow-up). Results Population: In total, 418 patients were enrolled in 15 centres: 176 patients in group 1 (mean: 79.4 years) and 242 patients in group 2 (mean: 52.7 years).CEAP clinical classes C4, C5 and C6, history of deep vein thrombosis (12.5%) and superficial vein thrombosis (11.9%), long-term anticoagulant therapy (9.1%) and antiplatelet therapy (16.5%) were more frequent in older patients.All types of veins were treated from saphenous veins to telangiectasias. Sclerotherapy features: There was no difference in concentration of the sclerosing agents. When foam sclerotherapy was used (84% of patients), the injected volume was lower in group 1. Complications: One vasovagal syncope occurred in group 1. One asymptomatic distal deep vein thrombosis, confined to the Medial Gastrocnemius Veins, was reported in both groups at one-month follow-up. Conclusions This study shows the feasibility and safety of sclerotherapy in older patients, with no specific complications nor need for special precautions.

Analysis of therapy effectiveness of deep vein thrombosis of lower limbs with warfarin and rivaroxaban in the long-term period

2020 ◽  
Author(s):  
А.А. Полянцев ◽  
Д.В. Фролов ◽  
Д.В. Линченко ◽  
Ю.В. Щелокова ◽  
Т.А. Литвинова ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Lower Limbs ◽  
Prophylactic Regimen ◽  
Therapy Regimen ◽  
Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Введение. Влияние стандартной и альтернативных схем антикоагулянтной терапии на степень и скорость реканализации глубоких вен привлекает внимание современных исследователей. Цель исследования: сравнение эффективности терапии тромбоза глубоких вен (ТГВ) нижних конечностей варфарином и ривароксабаном в отдаленном периоде. Материалы и методы. В исследование включено 94 пациента с ТГВ нижних конечностей, которые были разделены на 2 группы в зависимости от назначенной схемы лечения. Средний возраст 50 пациентов группы 1 составил 44,0 12,6 лет, 44 больных группы 2 39,5 11,7 лет. Пациентам группы 1 был назначен варфарин, группы 2 ривароксабан в течение 6 мес после выписки. Конечная точка наблюдения 4 года. Результаты. Прием антикоагулянта ранее установленного срока прекратили 18 (36) пациентов из группы 1 и 2 (4,5) пациента из группы 2. Режим эластической компрессии в обеих группах пациенты соблюдали нерегулярно. Рецидив венозных тромбоэмболических осложнений в группе 1 отмечен в 11 (22) случаях, в группе 2 у 7 (15,9) пациентов. Отрицательная динамика ультразвукового обследования складывалась у пациентов обеих групп: у 16 пациентов группы 1 и у 9,1 группы 2 появились признаки поражения ранее неизмененных вен или окклюзия ранее проходимой вены после перенесенного тромбоза без клиники острого венозного тромбоза в анамнезе. Трофические расстройства отмечены у одного пациента группы 2 и у 1/3 пациентов группы 1 к четвертому году наблюдения. Значимые отличия между группами были получены по таким параметрам, как приверженность к лечению и степень тяжести венозной недостаточности, оцениваемая клинически, в пользу ривароксабана. Заключение. Неудовлетворительные результаты лечения при использовании стандартной схемы терапии ТГВ требуют назначения препаратов из группы новых оральных антикоагулянтов с возможным внедрением схемы профилактического приема. Introduction. Effect of standard and alternative anticoagulant therapy regimens on the degree and rapidity of deep vein recanalization attracts the attention of modern researchers. Aim: to compare the treatment effectiveness of deep vein thrombosis (DVT) of lower limbs with warfarin and rivaroxaban in the long-term period. Materials and methods. The study included 94 patients with DVT of lower limbs they were divided into 2 groups depending on the prescribed treatment regimen. The average age of 50 patients of group 1 was 44.0 12.6 years, 44 patients of group 2 39.5 11.7 years. Warfarin was prescribed to patients of group 1, rivaroxaban to patients of group 2 treatment was prescribed for 6 months after discharge. The endpoint of observation was 4 years. Results. 18 (36) patients from group 1 and 2 (4.5) patients from group 2 stopped taking the anticoagulant earlier than target date. Elastic compression treatment patients in both groups kept irregularly. Recurrence of venous thromboembolic complications in group 1 was noted in 11 (22) cases, in group 2 in 7 (15.9) patients. The negative ultrasound dynamics was observed in patients of both groups: 16 of patients in group 1 and 9.1 in group 2 had lesion signs of previously unchanged veins or occlusion of a previously passable vein after thrombosis without clinic of acute venous thrombosis. Trophic disorders were identified in 1 patient in group 2 and in 1/3 of patients in group 1 by the 4th year of observation. Significant differences between the groups were obtained in favor of rivaroxaban according to such parameters as adherence to treatment and the severity of venous insufficiency. Conclusion. Unsatisfactory results of DVT treatment with standard therapy regimen require the administration of new oral anticoagulants with the possible introduction of prophylactic regimen.

Role of Anticoagulation in Patients with Inferior Vena Cava Filter but with No Risk Factor or History of DVT/PE

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4317-4317
Author(s):  
Mustapha A. Khalife ◽  
Vrushali S. Dabak ◽  
Marwa Hammoud ◽  
Karim Arnaout
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Vein Thrombosis ◽  
History Of ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Abstract Abstract 4317 Introduction: Inferior Vena Cava (IVC) filters have been available for almost 40 years but their clinical utility and safety have not been completely evaluated in patients with no previous history of deep vein thrombosis (DVT) or pulmonary embolism (PE). The role of anticoagulation in patients with IVC filter with no history of DVT/PE is questionable. In this study, we try to determine if there is a role or benefit from anticoagulation in patients with an IVC filter placed but without any other risk factor for deep vein thrombosis (DVT) or pulmonary embolism (PE). Methods: we retrospectively reviewed the charts of 562 patients who had an IVC filter placed between 2003 and 2005. 442 patients were excluded because they had a history of DVT/PE, or because of a hypercoagulable state (genetic predisposition, prolonged hospitalization/immobilization, surgery, or malignancy). Of the 120 remaining patients included in this study, 6 had their IVC filter removed. And therefore we only analyzed the charts of 114 patients who had a permanent IVC filter placed for prophylactic reasons. Group 1 consisted of 17 patients who received different forms of anticoagulation (subcutaneous heparin, low molecular weight heparin or coumadin). Group 2 consisted of the remaining 97 patients who did not receive any form of anticoagulation. Results: 2 out of 17 patients in group 1 had a DVT and 14 out of 97 patients in group 2 had a DVT. The incidence of DVT was 11.8% in group 1 versus 14.4% in group 2 (p-value 0.770). The median onset of DVT/PE after IVC filter placement was 31 days. The median time of follow up was 77.33 months. Conclusion: Patients who had a permanent prophylactic IVC filter placed but with no history or risk factors for DVT/PE appear to be at an elevated risk for new DVT/PEs. In these patients, the role of anticoagulation is questionable. With a median 6 year follow up, anticoagulation seemed to non significantly lower the risk of DVT/PE. Larger randomized prospective trials are needed to examine the efficacy and duration of anticoagulation in patients with a prophylactic IVC filter placed. Disclosures: No relevant conflicts of interest to declare.

PLASMINOGEN ACTIVATOR INHIBITOR ACTIVITY AND ANTIGEN (PAI 1), RELATIONSHIP TO FIBRINOLYTIC RESPONSE AFTER VENOUS OCCLUSION IN 48 PATIENTS WITH DEEP VEIN THROMBOSIS

1987 ◽  
Author(s):  
G Nguyen ◽  
M H Horellou ◽  
J Conard ◽  
P Van Dreden ◽  
E K O Kruithof ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Plasminogen Activator ◽  
Venous Occlusion ◽  
Venous Stasis ◽  
Activity Levels ◽  
Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Pai 1 ◽  
Group 1

Fibrinolytic parameters were studied before and after a 10 minute venous occlusion (VO) in 48 patients with confirmed deep vein thrombosis (DVT), at least 3 months after the last thrombotic episode. Congenital antithrombin III or protein C deficiencies were ruled out in these patients. The following tests were performed : euglobulin clot lysis time (ECLT), diluted whole blood lysis times (DWBLT), tissue plasminogen activator (t-PA) antigen (Biopool kit) and activity (fibrin plates), PAI activity (Verheijen et al.) and PAI i antigen (RIA, Kruithof et al.).Patients were divided in 2 groups : group 1 (27 patients) with normal fibrinolytic response (ECLT and DWBLT less than 90 min. after VO), group 2 (21 patients) with defective fibrinolytic response at least twice with a few weeks time interval. In group 1, the mean t-PA antigen release after VO was 32.0 ± 27.2 ng/ml (post-occlusion value minus preocclusion value) and was associated with low or normal levels of basal PAI activity (7.1 ±3.1 IU/ml), and PAI 1 antigen (15.1 ±4.1 ng/ml, n = 7). These results could explain the good response to VO, and a PAI activity suppression after stasis (PAI activity undetectable in 20 out of 27 patients).In contrast, in group 2, a low t-PA Ag increase after VO:10.5 ± 8.2 ng/ml as compared to group 1 (p <0.001) was associated with high levels of basal PAI activity : 22.4 ± 15.4 IU/ml (p <0.001), and PAI 1 Ag : 43.6 ± 24.9 ng/ml (n = 11, p <0.001). This association may account for the impaired fibrinolytic response aftep V0, and for persistant high PAI activity levels after stasis (17.6 ± 22.5 IU/ml). Before V0, PAI 1 Ag levels were in good correlation with PAI activity (r = 0.66, p <0.01), and , were significantly higher in group 2 as compared to group 1 (only 3 patients belonging to group 2 had normal PAI levels).Since elevated PAI 1 antigen and PAI activity levels were associated with an abnormal fibrinolytic response to venous stasis, VO test could be restricted to patients with normal PAI levels, in order to detect hypofibrinolysis related to insufficient t-PA release.

Prognostic significance of concomitant superficial vein thrombosis in patients with deep vein thrombosis of the lower limbs

2021 ◽  
Author(s):  
Álvaro Dubois-Silva ◽  
Cristina Barbagelata-López ◽  
Patricia Piñeiro-Parga ◽  
Iria Francisco ◽  
Conxita Falgà ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Major Bleeding ◽  
Lower Limb ◽  
Prognostic Significance ◽  
Superficial Vein ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Superficial Vein Thrombosis ◽  
Deep Vein

<b>Background: </b>The prognostic significance of concomitant superficial vein thrombosis (SVT) in patients with lower-limb deep vein thrombosis (DVT) has not been consistently evaluated. <b>Methods: </b>We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry to compare the rates of subsequent PE, recurrent DVT, major bleeding or death in patients with lower-limb DVT, according to the presence or absence of concomitant SVT. <b>Results: </b>Since March 2015 to May 2020, there were 8,743 patients with lower-limb DVT. Of these, 745 (8.5%) had concomitant SVT. Most patients (97.4% in both subgroups) received anticoagulant therapy (median duration, 138 vs. 147 days). During follow-up (median, 193 vs. 210 days), 156 (1.8%) patients developed subsequent PE, 336 (3.8%) had recurrent DVT, 201 (2.3%) had major bleeding and 844 (9.7%) died. Patients with concomitant SVT had a higher rate of subsequent PE (rate ratio [RR]: 2.11; 95%CI: 1.33-3.24) than those with isolated DVT, with no significant differences in the rates of recurrent DVT (RR: 0.80; 95%CI: 0.50-1.21), major bleeding (RR: 0.77; 95%CI: 0.41-1.33) or death (RR: 0.81; 95%CI: 0.61-1.06). On multivariable analysis, patients with DVT and SVT concomitantly were at increased risk for subsequent PE during anticoagulation (adjusted hazard ratio [HR]: 2.23; 95%CI: 1.22-4.05) and also during the entire follow-up period (adjusted HR: 2.33; 95%CI: 1.49-3.66). <b>Conclusion:</b> Patients with lower-limb DVT and SVT concomitantly are at increased risk to develop PE. Further studies are needed to externally validate our findings and to determine if these patients could benefit from a different management strategy.

Prospective 12-Year Follow-up Study of Clinical and Hemodynamic Sequelae After Deep Vein Thrombosis in Low-Risk Patients (Zürich Study)

Circulation ◽  
1996 ◽  
Vol 93 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Ulrich K. Franzeck ◽  
Ilse Schalch ◽  
Kurt A. Jäger ◽  
Ernst Schneider ◽  
Jörg Grimm ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Low Risk ◽  
Vein Thrombosis ◽  
Follow Up Study ◽  
Risk Patients ◽  
Deep Vein

Post-thrombotic syndrome after deep vein thrombosis: The role of follow-up Doppler ultrasound

2021 ◽  
Vol 156 (5) ◽  
pp. 251-252
Author(s):  
Francisco Galeano-Valle ◽  
Jorge del-Toro-Cervera ◽  
Pablo Demelo-Rodríguez
Keyword(s):  
Deep Vein Thrombosis ◽  
Doppler Ultrasound ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Deep Vein

scholarly journals Predictors of long-term post-thrombotic syndrome following high proximal deep vein thrombosis: a cross-sectional study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Marit Engeseth ◽  
Tone Enden ◽  
Per Morten Sandset ◽  
Hilde Skuterud Wik
Keyword(s):  
Deep Vein Thrombosis ◽  
Proximal Deep Vein Thrombosis ◽  
Cross Sectional ◽  
Clinical Criteria ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Younger Age ◽  
Deep Vein

Abstract Background Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT. Methods During 2006–09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (> 1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression. Results Eighty-eight patients (52%) were included 8–10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93–0.99), and 1.23 (95% CI, 1.02–1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments. Conclusions In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.

The development of valvular incompetence after deep vein thrombosis: A follow-up study with duplex scanning

1994 ◽  
Vol 19 (6) ◽  
pp. 1059-1066 ◽  
Author(s):  
Bert van Ramshorst ◽  
Paul S. van Bemmelen ◽  
Hans Hoeneveld ◽  
Bert C. Eikelboom
Keyword(s):  
Deep Vein Thrombosis ◽  
Duplex Scanning ◽  
Vein Thrombosis ◽  
Follow Up Study ◽  
Deep Vein

scholarly journals Reduction of the Risk of Relapse of Symptoms When Using Esophagoprotector in Patients Requiring Temporary Cancellation of Antisecretory Therapy

2021 ◽  
Vol 17 (16) ◽  
pp. 26-30
Author(s):  
Yu.A. Kucheryavy ◽  
◽  
P.R. Movtaeva ◽  
D.N. Andreev ◽  
R.I. Shaburov ◽  
...  
Keyword(s):  
Comparative Study ◽  
Underlying Disease ◽  
On Demand ◽  
Long Time ◽  
Prospective Comparative Study ◽  
Group 2 ◽  
Significant Regression ◽  
Risk Of Relapse ◽  
Group 1

Objective: to evaluate the effectiveness of an esophagoprotector in reducing the risk of recurrent symptoms of gastroesophageal reflux disease (GERD) in patients who requiring temporary cancellation of therapy with proton pump inhibitors (PPIs). Material and methods. For the prospective comparative study there were selectively chose patients who had been taking PPIs for a long time (at least one month) for the underlying disease and who required temporary discontinuation of antisecretory therapy due to objective medical reasons. The study included patients with endoscopically and/or pH-metrically verified GERD, as well as histologically verified Barrett's esophagus. In the process of randomization of patients, two equal groups were formed, depending on the therapy received at the time of PPI withdrawal: group 1 received antacids on demand, group 2 received antacids on demand, as well as the esophagoprotector Alfasoxx at a dose of 10 ml four times a day (after each meal and at night). The follow-up period was two weeks. The patients recorded episodes of heartburn in their personal diaries. Results. The study included 60 patients (28 men and 32 women). The average age of the examined patients was 43.1 ± 5.3 years. By the end of the two-week follow-up period, the frequency of recurrent symptoms in group 1 was 36.7%, while in group 2 it was 13.3%. The use of the esophagoprotector Alfasoxx contributed to the significant regression of the risk of heartburn recurrence (odds ratio 0.2657; 95% confidence interval (CI) 0.07328-0.9637; p = 0.0438) in comparison with the group of patients who received only antacids in the on-demand mode. When analyzing the population of patients who had relapsed symptoms, it was demonstrated that the average number of heartburn episodes in group 1 was 6.18 (95% CI 4,1930-8,1706), and in group 2 – 4.50 (95% CI 0,7121-8,2879). Conclusion. This prospective comparative study demonstrated that the use of the esophagoprotector Alfasoxx helps to reduce the risk of relapse of GERD symptoms in patients requiring temporary cancellation of PPI therapy.

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