Chest
Original ResearchAntithrombotic TherapyPharmacologic and Compression Therapies for Postthrombotic Syndrome: A Systematic Review of Randomized Controlled Trials
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
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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.
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