Quality-of-life in interventionally treated patients with post-thrombotic syndrome

Catarinella, Fabio S.; Nieman, Fhm; Wolf, Mark A.; Toonder, Irwin M.; Graaf, Rick de; Wittens, Cees H. A.

doi:10.1177/0268355515569431

Cited by 25 publications

(39 citation statements)

References 14 publications

(17 reference statements)

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“…12 Postthrombotic syndrome is also associated with severe clinical symptoms, such as chronic lower limbs pain, intractable edema, varicose veins, skin alterations, and venous ulcer. 13 Iliofemoral deep venous thrombosis is a strong risk factor for developing PTS, resulting in a reduction in the quality of life. Treatment with thrombolysis is aimed to lower PTS morbidity.…”

Section: Discussionmentioning

confidence: 99%

Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

Tang

Chen

et al. 2019

Clin Appl Thromb Hemost

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Early catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) can reduce postthrombotic morbidity. Pharmacomechanical thrombolysis (PMT) is a new therapy that can be selected for the treatment of iliofemoral deep vein thrombosis (IFDVT). We performed a meta-analysis of clinical trials comparing PMT versus CDT for treatment of acute IFDVT. Literature on this topic published between January 1, 1990, and June 1, 2018, was identified using PubMed, Embase, Cochrane Library, and Web of Science. Six trials were included in the meta-analysis. Compared to CDT, PMT significantly reduced the Villalta score ( P = .007; I 2 = 0%), thrombus score ( P = .01; I 2 = 0%), the duration in the hospital ( P = .03; I 2 = 64%), and thrombolysis time ( P < .00001, I 2 = 0%). There was no significant difference in valvular incompetence events ( P = .21; I 2 = 0%), minor bleeding events ( P = .59; I 2 = 0%), stent events ( P = .09; I 2 = 24%), and clot reduction grade I events ( P = .16; I 2 = 43%) between PMT and CDT. Subgroup analysis was performed by dividing the clot reduction grade I events group into PMT plus CDT versus CDT group and significant differences were found ( P = .03, I 2 = 0%) as well as for PMT alone versus CDT group ( P = .88, I 2 = 37%). This meta-analysis shows that PMT reduces the severity of postthrombotic syndrome (PTS), thrombus score, duration in hospital, and thrombolysis time compared to CDT. More specifically, PMT plus CDT reduces clot reduction grade I events. No significant difference in valvular incompetence events, stent events, and minor bleeding events were found when PMT was compared to CDT.

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Section: Discussionmentioning

confidence: 99%

Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

Tang

Chen

et al. 2019

Clin Appl Thromb Hemost

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“…Similarly, in a prospective evaluation of QOL in patients with DVT, Khan et al reported that the average quality of life adjusted year (QALY) at 4 months following a DVT was similar to the general population; however, the presence of PTS was associated with poorer QOL score 9. Finally, in a study by Catarinella et al intervention on ILVC with stenting improved QOL in patients with or without PTS at 24-month follow-up 10…”

Section: Epidemiology Symptoms and Quality Of Life Of Patients With mentioning

confidence: 95%

<p>Iliac vein compression: epidemiology, diagnosis and treatment</p>

Radaideh¹,

Patel²,

Shammas³

2019

VHRM

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Iliac vein compression (LIVC) is a prevalent finding in the general population, but a smaller number of patients are symptomatic. ILVC should be considered in symptomatic patients with unexplained unilateral lower leg swelling. Patients typically complain of one or more of the following symptoms: lower leg pain, heaviness, venous claudication, swelling, hyperpigmentation and ulceration. ILVC can be thrombotic, combined with acute or chronic DVT, or non-thrombotic. ILVC is best diagnosed with intravascular ultrasound (IVUS), but computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have emerged as valid screening tests. Venography underestimates the severity of ILVC but may provide insights into the anatomy and the presence of collaterals. Based on current available evidence, endovascular therapy with stenting remains the main treatment strategy for ILVC. Dedicated nitinol venous stents are currently under review by the Food and Drug Administration for potential approval in the United States. These stents have been released outside the US. There is no consensus to the optimal anticoagulation regimen post-ILVC stenting. Oral anticoagulants, however, remain a preferred therapy in patients with history of thrombotic ILVC.

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“…Both scales theoretically lie between 0 and 100 (visual analogue scale) with a higher score indicating a higher quality of life. 18 19 20 We defined dedicated ECS use as use of the ECS for at least six days a week, moderate use as four to five days a week, and poor use less than four days a week. We defined recurrent ipsilateral deep venous thrombosis as a new non-compressible venous segment compared with the original compression ultrasound images of the index deep venous thrombosis or a pronounced increase in vein diameter on compression.…”

Section: Methodsmentioning

confidence: 99%

One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): randomised controlled trial

Mol

Ree

Klok

et al. 2016

BMJ

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Objective To study whether stopping elastic compression stockings (ECS) after 12 months is non-inferior to continuing them for 24 months after proximal deep venous thrombosis.Design Multicentre single blind non-inferiority randomised controlled trial.Setting Outpatient clinics in eight teaching hospitals in the Netherlands, including one university medical centre.Participants Patients compliant with compression therapy for 12 months after symptomatic, ultrasound proven proximal deep venous thrombosis of the leg.Interventions Continuation or cessation of ECS 12 months after deep venous thrombosis.Main outcome measures The primary outcome was the incidence of post-thrombotic syndrome 24 months after diagnosis of deep venous thrombosis, as assessed by the standardised Villalta scale in an intention to treat analysis. The predefined non-inferiority margin was 10%. The main secondary outcome was quality of life (VEINES-QOL/Sym).Results 518 patients compliant with ECS and free of post-thrombotic syndrome were randomised one year after diagnosis of deep venous thrombosis to stop or continue ECS therapy for another year. In the stop-ECS group, 51 of 256 patients developed post-thrombotic syndrome, with an incidence of 19.9% (95% confidence interval 16% to 24%). In the continue-ECS group, 34 of 262 patients developed post-thrombotic syndrome (incidence 13.0%, 9.9% to 17%), of whom 85% used ECS six or seven days a week during the study period, for an absolute difference of 6.9% (95% confidence interval upper limit 12.3%). Because the upper limit of the 95% confidence interval exceeds the predefined margin of 10%, non-inferiority was not reached. The number needed to treat to prevent one case of post-thrombotic syndrome by continuing ECS was 14 (95% confidence interval lower limit 8). Quality of life did not differ between the two groups.Conclusion Stopping ECS after one year in compliant patients with proximal deep venous thrombosis seemed not to be non-inferior to continuing ECS therapy for two years in this non-inferiority trial.Trial registration Netherlands Trial Register NTR1442.

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Quality-of-life in interventionally treated patients with post-thrombotic syndrome

Cited by 25 publications

References 14 publications

Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

<p>Iliac vein compression: epidemiology, diagnosis and treatment</p>

One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): randomised controlled trial

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