Chest
Volume 141, Issue 2, February 2012, Pages 308-320
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Original Research
Antithrombotic Therapy
Pharmacologic and Compression Therapies for Postthrombotic Syndrome: A Systematic Review of Randomized Controlled Trials

https://doi.org/10.1378/chest.11-1175Get rights and content

Background

Postthrombotic syndrome (PTS) is a frequent, chronic complication of DVT. The effectiveness and safety of available treatments are unknown. The objective of this study was to systematically review the literature to assess whether pharmacologic and compression therapies are effective and safe for the treatment of PTS.

Methods

We sought to identify randomized controlled trials (RCTs) via a search of PubMed, studies referenced in included publications, and studies that cited relevant literature.

Results

A total of 121 titles were reviewed, 12 full-text publications were assessed for inclusion, and seven RCTs, including 703 patients, were selected for inclusion. Four trials assessed the effectiveness of drugs, including rutosides, hidrosmin, and defibrotide, and four trials assessed compression therapies for treatment of PTS. Systems for the diagnosis and classification of PTS severity varied across studies. Three of four drug therapy trials reported moderate improvement in selected PTS symptoms, minor changes in calf and ankle circumference, and some effects on ulcer healing. Two studies of compression stockings did not report benefit. Two studies that assessed compression devices reported improvement in PTS symptoms scores; one of these reported an improvement in quality-of-life score.

Conclusions

There is limited and low-quality evidence for the effectiveness of rutosides, hidrosmin, defibrotide, and compression stockings, but moderate-quality evidence that supports the use of intermittent compression to provide at least short-term relief from PTS. More rigorous studies are needed to assess the short- and long-term effectiveness and safety of PTS therapies.

Section snippets

Eligibility

The population of interest was patients with PTS defined by the prior diagnosis of a DVT in the affected limb. The interventions of interest included drug therapy or compression therapy, including continuous or intermittent compression therapy with stockings or pneumatic devices. The control group of interest was not specified and may have included an active intervention. The outcomes of interest were improvement in patient symptoms, success or failure of the intervention, ulcer healing,

Study Characteristics

We screened a total of 121 citations identified by the search strategy. We retrieved and screened the full text of 12 publications judged as potentially eligible. Of these, we included seven trials in the review (Fig 1, Table 1). Four trials (three parallel RCTs and one crossover RCT), including 521 patients, assessed the effectiveness of various drugs for the treatment of PTS.11, 12, 13, 14 These pharmacotherapies included rutosides, hidrosmin, and defibrotide, and treatment durations ranged

Discussion

We systematically reviewed the clinical trial literature to assess the effectiveness and safety of pharmacologic and compression therapies for the treatment of PTS. Treatments assessed in the reviewed studies included rutosides, hidrosmin, defibrotide, continuous compression, and IPC therapies. In our review, we found that there was some symptom improvement of a small magnitude associated with pharmacologic and compression therapies, although hidrosmin may be useful for ulcer healing, and IPC

Conclusions

There is limited and low-quality clinical trial evidence for the effectiveness of rutosides, hidrosmin, and defibrotide to treat PTS. There is also limited and low-quality evidence for the effectiveness of GCS, but there is moderate-quality evidence for the effectiveness of IPC devices, which seem to provide at least short-term relief from moderate to severe PTS. Therefore, our results suggest that IPC devices should be tried in patients with moderate to severe PTS, and short-term use of

Acknowledgments

Author contributions: Dr Kahn served as the guarantor of the paper, and takes responsibility for the integrity of the work as a whole, from inception to published article.

Ms Cohen: contributed to the concept and design of the study, acquisition of data via database searches, selection of studies for inclusion, data extraction, preparation of the first draft of the manuscript, critical revision of the article, and provision of final approval of the version to be published.

Dr Akl: contributed to

References (39)

  • P Prandoni et al.

    Post-thrombotic syndrome: prevalence, prognostication and need for progress

    Br J Haematol

    (2009)
  • P Prandoni et al.

    The long-term clinical course of acute deep venous thrombosis

    Ann Intern Med

    (1996)
  • D Bergqvist et al.

    Cost of long-term complications of deep venous thrombosis of the lower extremities: an analysis of a defined patient population in Sweden

    Ann Intern Med

    (1997)
  • DA MacDougall et al.

    Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome

    Am J Health Syst Pharm

    (2006)
  • AA Ashrani et al.

    Incidence and cost burden of post-thrombotic syndrome

    J Thromb Thrombolysis

    (2009)
  • RT Bond et al.

    Systematic review of the surgical treatment of moderate to severe post-thrombotic syndrome [abstract]

    Blood (ASH Annual Meeting Abstracts)

    (2010)
  • AB de Jongste et al.

    A double blind three center clinical trial on the short-term efficacy of 0-(beta-hydroxyethyl)-rutosides in patients with post-thrombotic syndrome

    Thromb Haemost

    (1989)
  • M Monreal et al.

    A prospective study of the long-term efficacy of two different venoactive drugs in patients with post-thrombotic syndrome

    Phlebology

    (1994)
  • S Coccheri et al.

    Effects of defibrotide in patients with chronic deep insufficiency. The PROVEDIS study

    Int Angiol

    (2004)
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    Funding/Support: Dr Kahn is supported by a National Investigator (chercheur national) award of the Fonds de la recherche en santé duQuébec (FRSQ). Ms Cohen receives a doctoral training award from the FRSQ.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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