scholarly journals Catheter-Based Therapies and Other Management Strategies for Deep Vein Thrombosis and Post-Thrombotic Syndrome

2020 ◽  
Vol 9 (5) ◽  
pp. 1439 ◽  
Author(s):  
Siddhant Thukral ◽  
Suresh Vedantham
Keyword(s):  
Deep Vein Thrombosis ◽  
Management Strategies ◽  
Patient Centered ◽  
Specific Patient ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Patient Morbidity ◽  
Patient Groups ◽  
Deep Vein

Acute deep vein thrombosis (DVT) causes substantial short-term and long-term patient morbidity. Medical, lifestyle, and compressive therapies have been investigated for the prevention of pulmonary embolism (PE) and recurrence of venous thromboembolism (VTE). However, patient-centered outcomes such as resolution of presenting DVT symptoms and late occurrence of post-thrombotic syndrome (PTS) have not been prioritized to the same degree. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups.

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.

scholarly journals Iliofemoral deep vein thrombosis and the problem of post-thrombotic syndrome

2018 ◽  
Vol 17 (2) ◽  
pp. 99-103
Author(s):  
Nicholas Denny ◽  
◽  
Shreshta Musale ◽  
Helena Edlin ◽  
Jecko Thachil ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Compression Stockings ◽  
Short Term ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Catheter Directed Thrombolysis ◽  
Short Term Mortality ◽  
Considerable Morbidity ◽  
Deep Vein

Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Among the different presentations of DVT, thrombus in the iliofemoral veins may be considered the severest form. Although anticoagulation is the mainstay of the management of iliofemoral thrombosis, despite adequate anticoagulant treatment, complications including post-thrombotic syndrome is not uncommon. The latter is often overlooked but can cause considerable morbidity to the affected individuals. Preventing this condition remains a challenge but recent clinical trials of catheter directed thrombolysis and elasticated compression stockings provide some advance in this context. In this article, with the aid of a clinical case, we review the particular considerations to take into account when managing patients with an iliofemoral DVT.

scholarly journals Concomitant Use of Diosmin/Hesperidin and Oral Rivaroxaban Increases Deep Vein Recanalization and Reduces the Incidence of Post-Thrombotic Syndrome in Patients with Proximal Deep Vein Thrombosis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 986-986
Author(s):  
Kirill Lobastov ◽  
Iliya Schastlivtsev ◽  
Victor Barinov
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Severity ◽  
Proximal Deep Vein Thrombosis ◽  
Control Groups ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
And Control ◽  
Deep Vein ◽  
The Impact

Abstract Aim: To assess the impact of long-term Diosmin/Hesperidin use in the treatment of proximal deep vein thrombosis (DVT). Methods: This study was a pilot randomized open-label study with blinded outcome assessor - enrolled patients with their first episodes of popliteal-femoral DVT confirmed by duplex ultrasound (DUS). All participants were randomized into two groups: 1.) control that received a standard treatment with oral Rivaroxaban, and 2.) experimental that required additional treatment with Diosmin/Hesperidin 450/50 mg twice a day. Both drugs were used for six months. Patients were followed-up for the whole treatment period with series DUS every two months in order to evaluate the degree of recanalization by popliteal (PV), superficial femoral (SFV), and common femoral (CFV) veins' compressibility. Thrombi extension was assessed by modified Marder score. At the end of the follow-up period, patients were assessed with Villalta and venous clinical severity scores. Post-thrombotic syndrome (PTS) was diagnosed in those who had ≥5 Villalta score. Results: Sixty patients were randomized to the control and experimental groups (n=30 in each group). There were 40 men and 20 women with mean age of 56.3±13.4. Clinically unprovoked DVT was recognized in 65% of cases and left side localization in 45%. The median of Marder baseline scores were 15.0±4.8 and 11.1±4.3 in the experimental and control groups, respectively (p=0.002). After six months of treatment, the Marder score decreased to 0.8±1.6 and 2.8±3.5 in the main control groups, respectively (p=0.006). The generalized linear model repeated measures found a greater reduction in the Marder score (р <0.0001) and increased speed of recanalization on SFV (р <0.0001) with a non-significant tendency in the CFV (p=0.130) and PV (p=0.204) in the experimental group compared to the control one. Full recanalization of the PV at six months was observed in 24 patients (80%), who had received Diosmin/Hesperidin, and only in 17 persons (57%) of the control group (p=0.047). The median of Villalta score in the group treated with Diosmin/Hesperidin was significantly lower compared to the control one (2.9±2.7 versus 5.8±3.0 [p <0.0001]). The same difference was found for VCSS score (2.3±1.9 versus 4.9±1.9 [p <0001]). According to the Villalta score, PTS was recognized in six patients (20%) and 17 patients (57%) in the experimental and control groups, respectively (p=0.004). Conclusion: Long-term treatment with Diosmin/Hesperidin can increase the speed of deep vein recanalization and reduce the incidence of PTS diagnosed at six months in patients with proximal DVT treated with oral rivaroxaban. Disclosures Lobastov: Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Schastlivtsev:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Barinov:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau.

Long-term follow-up of patients with suspected deep vein thrombosis of the upper extremity: survival, risk factors and post-thrombotic syndrome

2004 ◽  
Vol 15 (8) ◽  
pp. 503-507 ◽  
Author(s):  
Henk J. Baarslag ◽  
Maria M.W. Koopman ◽  
Barbara A. Hutten ◽  
May W. Linthorst Homan ◽  
Harry R. Büller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Long Term Follow Up ◽  
Survival Risk ◽  
Deep Vein

scholarly journals Endovascular Therapy for the Management of Acute Ilio-femoral Deep Vein Thrombosis

Phlebologie ◽  
2021 ◽  
Author(s):  
Mert Dumantepe
Keyword(s):  
Deep Vein Thrombosis ◽  
Endovascular Therapy ◽  
High Rate ◽  
Bleeding Complications ◽  
Postthrombotic Syndrome ◽  
Specific Patient ◽  
Acute Thrombosis ◽  
Vein Thrombosis ◽  
Patient Groups ◽  
Deep Vein

AbstractIlio-femoral deep vein thrombosis (DVT) has a high rate of long-term morbidity in the form of the postthrombotic syndrome (PTS). Therefore, management of acute thrombosis should not only focus on the prevention of acute complications such as propagation or embolisation of the initial clot but also on preventing recurrent thrombosis and PTS. Contemporary catheter-based treatments of deep vein thrombosis have proven to be safe and effective in selected patients. Current guidelines recommend medical therapy with anticoagulation alone for all but the most severe, limb-threatening thrombosis. They additionally allow for consideration of endovascular catheter-based treatment in selected patients with acute proximal ilio-femoral DVT and low risk of bleeding complications to prevent PTS. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups with acute iliofemoral DVT.

scholarly journals Patient Management Strategies and Long-Term Outcomes in Isolated Distal Deep-Vein Thrombosis versus Proximal Deep-Vein Thrombosis: Findings from XALIA

TH Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e85-e93 ◽  
Author(s):  
Walter Ageno ◽  
Lorenzo Mantovani ◽  
Sylvia Haas ◽  
Reinhold Kreutz ◽  
Danja Monje ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Major Bleeding ◽  
Management Strategies ◽  
Vein Thrombosis ◽  
Recurrent Venous Thromboembolism ◽  
Registration Number ◽  
Deep Vein ◽  
To Receive

Background Overall, 30 to 50% of lower-limb deep-vein thrombosis (DVT) cases are isolated distal DVT (IDDVT). The recurrent venous thromboembolism (VTE) risk is unclear, leaving uncertainty over optimal IDDVT treatment. We present data on patients with IDDVT and proximal DVT (PDVT) from the prospective, noninterventional XALIA study of rivaroxaban for acute and extended VTE treatment. Methods Patients aged ≥18 years scheduled to receive ≥3 months' anticoagulation with rivaroxaban or standard anticoagulation were eligible, with follow-up for ≥12 months. We describe baseline characteristics, management strategies, and incidence proportions of VTE recurrence, major bleeding, and all-cause mortality in patients with IDDVT or PDVT, with or without distal vein involvement. Findings Overall, 1,004 patients with IDDVT and 3,098 with PDVT were enrolled; 641 (63.8%) and 1,683 (54.3%) received rivaroxaban, respectively. Patients with IDDVT were younger and had lower incidences of renal impairment, cancer, and unprovoked VTE than those with PDVT. On-treatment recurrence incidences for IDDVT versus PDVT were 1.0 versus 2.4% (adjusted hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.29–1.08), and incidences posttreatment cessation were 1.1 versus 2.1% (adjusted HR: 0.65; 95% CI: 0.32–1.35), respectively. On-treatment major bleeding incidences were 0.9 versus 1.4% and mortality was 0.8 versus 2.2%, respectively. Median treatment duration in patients with IDDVT was shorter than in those with PDVT (102 vs. 192 days, respectively). Interpretation Patients with IDDVT had fewer comorbidities and were more frequently treated with rivaroxaban than those with PDVT. On-treatment and posttreatment recurrences were less frequent in patients with IDDVT. Trial registration number: NCT01619007.

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

2020 ◽  
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 88 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.

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