Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV)

Quéré, Isabelle; Elias, Antoine; Maufus, Mario; Elias, Marie; Sevestre, M.-A.; Galanaud, J.-P.; Bosson, Jean‐Luc; Bura-Rivière, A.; Jurus, C.; Lacroix, Philippe; Zuily, Stéphane; Diard, A.; Wahl, D.; Bertoletti, Laurent; Brisot, D.; Frappé, Paul; Gillet, J.-L.; Ouvry, P.; Pernod, Gilles

doi:10.1016/j.jdmv.2018.12.003

Cited by 3 publications

(12 citation statements)

References 202 publications

(248 reference statements)

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“…Guidelines, even sometimes those issued in the same country, have heterogeneous recommendations. For example, in France, where the CELEST trial is conducted, one guideline recommends ECS for the prevention of PTS after DVT, and another one does not 18,21 . Differences in results for ECS efficacy for PTS prevention between studies may be due to a placebo effect or suboptimal compliance.…”

Section: Discussionmentioning

confidence: 99%

“…There are several potential explanations as to why rigorously conducted trials report opposite results, and ECS efficacy is now debated 14 . This lack of agreement on the efficacy of ECS among experts led to several guidelines no longer recommending ECS for the prevention of PTS, leaving physicians “empty handed.” 6,15‐21 In this article, we present an overview of the published clinical trials that have assessed the efficacy of ECS in the prevention of PTS after an acute DVT and examine their limitations. We will then present the protocol of the CELEST trial (Compression Elastique Evaluation du Syndrome post Thrombotique), a multicenter double‐blind RCT comparing high‐strength (ankle pressure 35 mm Hg) versus lower‐strength (ankle pressure 25 mm Hg) ECS to prevent PTS after proximal DVT.…”

Section: Introductionmentioning

confidence: 99%

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Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial

Galanaud

Genty-Vermorel

Rolland

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Postthrombotic syndrome (PTS) is a burdensome and costly complication of deep vein thrombosis (DVT) that develops in 20%‐40% of patients within 2 years after proximal DVT. In the absence of effective curative treatment, management of PTS relies on its prevention after DVT. The effectiveness of elastic compression stockings (ECS) to prevent PTS is uncertain. We present an overview of published studies assessing the efficacy of ECS to prevent PTS and present the protocol for the CELEST clinical trial. While previous open‐label randomized trials have reported a 50% risk reduction in PTS in patients treated with >30 mm Hg ankle pressure ECS, a large double‐blind trial reported no effect of ECS. We discuss the main potential limitations of these trials, including a placebo effect and suboptimal compliance to ECS. We present the protocol of the CELEST double‐blind randomized trial comparing 2 years of high strength (ankle pressure 35 mm Hg) versus lower strength (ankle pressure 25 mm Hg) ECS in the prevention of PTS after a first acute symptomatic, unilateral, proximal DVT. The use of lower‐strength ECS than that used in previous studies should favor compliance. CELEST may provide important evidence about the efficacy of ECS in the prevention of PTS after DVT. The results will be interpreted in the light of results from recent clinical trials assessing ECS for PTS prevention that reported that the duration of ECS use should be tailored to the individual, if ECS are efficacious in the prevention of PTS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial

Galanaud

Genty-Vermorel

Rolland

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…Some hematologists, as well as the SFMV, have argued for the treatment of upper extremity SVT using guidelines similar to that of the lower extremity, namely for thrombus that is greater than 5 cm in length or within 3 cm of the deep venous system. 16,18 Current Guidelines for Imaging Protocols of Upper/Lower Extremity SVT Recently published practice parameters and consensus statements for the ultrasound evaluation of VTE in the extremities produced since the publication of management guidelines do not include specific recommendations to evaluate superficial veins (Table 3).…”

Section: Management Of Upper Extremity Svtmentioning

confidence: 99%

Ultrasound Imaging of Superficial Venous Thrombosis in the Upper and Lower Extremities

Smith

Bagley

Guy

et al. 2021

J of Ultrasound Medicine

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Superficial venous thrombosis (SVT) of the upper and lower extremities has long been considered a relatively benign condition. But in recent years, the literature has suggested a benefit to anticoagulation in patients with certain thrombus characteristics (size, location, and distance to deep venous system) resulting in updates to clinical guidelines for the treatment of lower extremity SVT. Despite these now well‐established guidelines, there remains a paucity of guidance from national and international societies regarding the imaging of superficial veins when evaluating for venous thrombosis. We recommend potential strategies to close this gap.

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“…The French and European 2019 recommendations [41] , [46] , [49] , [50] on the management of PE in non-COVID-19 patients do not recommend DVT screening in asymptomatic patients.…”

Section: Should We Screen For Dvt?mentioning

confidence: 99%

“…The specificity of this test decreases with age, and the threshold value is adjusted by adding 10 × the number of years beyond the age of 50 years (500 ng/mL + [10 × years over fifty]). This adjustment has been validated and incorporated into updated clinical practice recommendations [46] , [49] , [50] , [51] . Given the significant increase in D-dimer levels associated with the inflammatory response in COVID-19, some authors have proposed readjusting the threshold value to 3.000 ng/mL [20] , with a sensitivity between 76.9% and 100%, a specificity between 67% and 94.9%, and a negative predictive value of 92.5% [25] .…”

Section: Should We Screen For Dvt?mentioning

confidence: 99%

How to screen and diagnose deep venous thrombosis (DVT) in patients hospitalized for or suspected of COVID-19 infection, outside the intensive care units

Sebuhyan

Mirailles

Crichi

et al. 2020

JMV-Journal de Médecine Vasculaire

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Introduction The Coronavirus disease-2019 outbreak (COVID-19) has been declared a pandemic by the World Health Organization. Studies report both a severe inflammatory syndrome and a procoagulant state in severe COVID-19 cases, with an increase of venous thromboembolism, including pulmonary embolism (PE) and deep vein thrombosis (DVT). In this context, we discuss the use of doppler ultrasonography (DUS) in the screening and diagnosis of DVT in ambulatory and hospitalized patients with, or suspected of having, COVID-19, outside the intensive care unit (ICU). Material and methods Non-systematic review of the literature. Results In patients hospitalized for or suspected of COVID-19 infection with the presence of either (a) DVT clinical symptoms, (b) a strong DVT clinical probability (Wells score > 2) or (c) elevated D-dimer levels without DVT clinical symptoms and without PE on lung CT angio-scan, DVT should be investigated with DUS. In the presence of PE diagnosed clinically and/or radiologically, additional systematic DVT screening using DUS is not recommended during the COVID-19 pandemic. The use of 4-points compression DUS for DVT screen and diagnosis is the most appropriate method in this context. Discussion Systematic DUS for DVT screening in asymptomatic COVID patients is not recommended unless the patient is in the ICU. This would increase the risk of unnecessarily exposing medical staff to SARS-CoV-2 and monopolizing limited resources during this period.

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Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV)

Cited by 3 publications

References 202 publications

Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial

Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial

Ultrasound Imaging of Superficial Venous Thrombosis in the Upper and Lower Extremities

How to screen and diagnose deep venous thrombosis (DVT) in patients hospitalized for or suspected of COVID-19 infection, outside the intensive care units

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