Superficial Venous Thrombosis and Venous Thromboembolism A Large, Prospective Epidemiologic Study

Abstract

et al. Br J Surg 2010;97:650-6.Conclusion: There are no differences between sclerotherapy results in patients treated for truncal varices with foam sclerotherapy regardless of whether compression therapy after the procedure is used for 1 or 5 days.Summary: There are no data on the optimal bandaging regimen after foam sclerotherapy for truncal varices. In Great Britain, 80% of the members of the Vascular Society of Great Britain and Ireland responding to a questionnaire, and who treated patients with sclerotherapy, indicated they used compression bandages, and 90% subsequently used compression stockings after compression bandaging. Duration of treatment ranged from 1 to 7 days for initial bandages, with compression stockings used for 7 to 14 days, with some surgeons recommending compression stockings for up to 3 months. The authors sought to determine whether duration of bandaging could be reduced after foam sclerotherapy for truncal varices.Patients with primary uncomplicated varicose veins were randomized after foam sclerotherapy treatment to wearing compression bandaging for 24 hours or 5 days. In each case after compression bandages were removed, thromboembolism deterrent (TED) stockings then used for a total of 14 days of compression after foam sclerotherapy. The primary end point of the study was the 6-week Aberdeen Varicose Vein Severity Score (AVVSS) and Buford pain score. The study randomized 124 legs, of which 61 were randomized to 24 hours of compression bandaging and 63 to 5 days of compression bandaging. Venous occlusion rates at 6 weeks were 90% and 89%, respectfully (P ϭ .842). There were no differences in phlebitis after 2 weeks (P ϭ .445), skin discoloration after 6 weeks (46% vs 40%; P ϭ .546). There were no differences between groups in the AVVSS from baseline to 2 weeks (-0.29 vs -0.80; P ϭ .717) or to 6 weeks (-5.89 vs -5.14; 95% confidence interval [CI] for the difference, -3.29 to 1.8; P ϭ .563). There were also no differences between groups in changes in the Buford pain score from baseline to 2 weeks (-9.04 vs -2.80, P ϭ .248) or to 6 weeks (-17.32 vs -8.46; 95% CI for the difference, -19.06 to 1.33; P ϭ .088). Finally, the two groups also did not demonstrate any differences in changes in the Short Form-36 score from baseline to 6 weeks (2.02 vs. 1.74; P ϭ .903).Comment: Foam sclerotherapy is replacing liquid sclerotherapy as the preferred method of sclerotherapy for patients with truncal varicosities. Compression after treatment is essential to optimal results. However, as the authors point out with respect to foam sclerotherapy, the optimal duration of compression after treatment has not been adequately studied. This study is good news for patients. Compression bandages are not comfortable, and the results indicate that 24 hours of compressive bandaging, followed by a TED stocking for a total of 2 weeks, is just as efficacious as 5 days of compressive bandaging, followed by a TED stocking for a total of 2 weeks. The study provides practical guidance for post-therapy bandaging of patients...

Fondaparinux for the Treatment of Superficial-Vein Thrombosis in the Legs

“…(8.3%; 95% CI, 6.0 to 10.6), 8 confirming that superficial-vein thrombosis is not a benign disease. The relative reduction of 85% in the risk of symptomatic events that we observed with 2.5 mg of fondaparinux daily as compared with placebo is consistent with the reduction in the risk of venous thromboembolic complications that has been observed in studies evaluating anticoagulant agents as compared with placebo or no therapy for prophylaxis [25][26][27][28] or treatment 29 of venous thromboembolism.…”

“…[1][2][3][4][5][6][7] In a large, prospective, observational study, the 3-month risk of such complications was 8.3%, with a 3.3% risk of deep-vein thrombosis or pulmonary embolism. 8 The treatment of this disease has not been adequately addressed in randomized trials. Accordingly, the recommendations in various guidelines are weak, and in practice, therapeutic strategies vary, ranging from no treatment to the use of antiinflammatory agents or anticoagulant drugs or surgery.…”

“…Accordingly, the recommendations in various guidelines are weak, and in practice, therapeutic strategies vary, ranging from no treatment to the use of antiinflammatory agents or anticoagulant drugs or surgery. [8][9][10][11][12][13][14] The few randomized studies that have been performed did not clarify the circumstances under which surgery is required or the value or optimal dose and duration of anticoagulant or antiinflammatory therapy. 6,[15][16][17][18][19] The results of the two largest studies, evaluating low-molecular-weight heparin, suggest that high-dose (therapeutic) or intermediate-dose regimens do not provide substantial benefits over low-dose (prophylactic) regimens and that a treatment period of 12 days or of 30 days is too short, with most symptomatic thromboembolic complications occurring after the treatment period.…”

“…7,9 This design was considered to be ethical, since all the patients benefited from close clinical monitoring, with adequate diagnostic procedures performed in the event of new or persistent symptoms, and since an independent data and safety monitoring committee carefully oversaw the study outcomes. The patients in our study are representative of those encountered in routine practice 1,2,8 : almost all were outpatients, and there was a clear predominance of women and a substantial proportion of obese patients, most presenting with varicose veins and superficial-vein thrombosis involving the great saphenous vein. The rate of symptomatic thromboembolic complications in the placebo group at day 47 (5.9%; 95% CI, 4.7 to 7.2) was in the low range of the expected rate of thromboembolic events, possibly because very-high-risk patients (e.g., those with active cancer or a recent history of venous thromboembolism and those in whom the thrombus was located within 3 cm of the saphenofemoral junction) were not enrolled in this placebo-controlled trial.…”

“…Patient safety was monitored by an independent data and safety monitoring committee. primary efficacy outcome, assuming an incidence of the primary efficacy outcome of 8.0% in the placebo group, 6,8,17 at a two-sided 5% level of significance. As planned, the independent steering committee, whose members were unaware of the group assignments, monitored the overall event rate for the primary efficacy outcome.…”