 |
|
Prevention and Treatment of Postphlebitic Syndrome
Results of a 3-Part Study
Jeffrey S. Ginsberg, MD;
Jack Hirsh, MD;
James Julian, MMath;
Mary Vander LaandeVries, RN;
Deborah Magier, RN;
Betsy MacKinnon, MSc;
Michael Gent, DSc
Arch Intern Med. 2001;161:2105-2109.
Background The true incidence of postphlebitic syndrome (PPS) following proximal
deep venous thrombosis (DVT) and the efficacy of graduated compression stockings
in preventing and treating PPS are unknown.
Methods A 3-part study of 202 patients evaluated 1 year after proximal DVT:
2 randomized placebo-controlled trials of stockings and 1 prospective cohort
of untreated patients. Patients were evaluated for PPS, using a standardized
questionnaire, and for venous valvular incompetence, using photoplethysmography
and venous Doppler. They were enrolled in study 1 or study 2 if they did not
have symptomatic PPS and did not have or had venous valvular incompetence,
respectively, and into study 3 if they had symptomatic PPS. Study 1 patients
were left untreated and followed up for development of PPS every 6 months
for a mean of 55 months. Study 2 patients were randomized to a below-knee
stocking (20-30 mm Hg) or a matched placebo stocking, and followed up for
development of PPS every 6 months for a mean of 57 months. Study 3 patients
were randomized to an active stocking (30-40 mm Hg) or a matched placebo stocking
and followed up every 3 months for treatment failure, defined a priori.
Results In study 1, 6 (5.0%) of 120 patients were categorized as treatment failures,
a rate similar to placebo-treated study 2 patients (P
= .10). In study 2, 0 (0%) of 24 active and 1 (4.3%) of 23 placebo-treated
patients were categorized as treatment failures (P
= .49). In study 3, 11 (61.1%) of 18 active and 10 (58.8%) of 17 placebo-treated
patients were categorized as treatment failures (P>.99).
Conclusions Most patients do not have PPS 1 year after proximal DVT, and do not
require stockings. We failed to show a benefit of stockings in patients with
PPS, but the small numbers preclude definitive conclusions.
From the Departments of Medicine (Drs Ginsberg and Hirsh and Mss Vander
LaandeVries and Magier) and Clinical Epidemiology and Biostatistics (Mr Julian,
Ms MacKinnon, and Dr Gent), McMaster University, Hamilton, Ontario.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Kearon et al.
Chest 2008;133:454S-545S.
ABSTRACT
| FULL TEXT
Current Treatment of Acute Lower Extremity Deep Venous Thrombosis
Janjigian and Muhs
INT J LOW EXTREM WOUNDS 2008;7:15-20.
ABSTRACT
Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians
Snow et al.
ANN INTERN MED 2007;146:204-210.
ABSTRACT
| FULL TEXT
Management of Venous Thromboembolism: A Systematic Review for a Practice Guideline
Segal et al.
ANN INTERN MED 2007;146:211-222.
ABSTRACT
| FULL TEXT
Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians
Snow et al.
Ann Fam Med 2007;5:74-80.
ABSTRACT
| FULL TEXT
Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome.
MacDougall et al.
Am J Health Syst Pharm 2006;63:S5-S15.
ABSTRACT
| FULL TEXT
Approach to Leg Edema of Unclear Etiology
Ely et al.
J Am Board Fam Med 2006;19:148-160.
ABSTRACT
| FULL TEXT
Oral Direct Thrombin Inhibitor Ximelagatran Compared with Warfarin for the Prevention of Venous Thromboembolism After Total Knee Arthroplasty
Colwell et al.
JBJS 2005;87:2169-2177.
ABSTRACT
| FULL TEXT
Antithrombotic Therapy for Venous Thromboembolic Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Buller et al.
Chest 2004;126:401S-428S.
ABSTRACT
| FULL TEXT
Below-Knee Elastic Compression Stockings To Prevent the Post-Thrombotic Syndrome: A Randomized, Controlled Trial
Prandoni et al.
ANN INTERN MED 2004;141:249-256.
ABSTRACT
| FULL TEXT
Routine Stocking Therapy after Deep Venous Thrombosis: A Clinical Dilemma
Ginsberg
ANN INTERN MED 2004;141:314-315.
FULL TEXT
Treatment of Deep-Vein Thrombosis
Bates and Ginsberg
NEJM 2004;351:268-277.
FULL TEXT
Relationship Between Deep Venous Thrombosis and the Postthrombotic Syndrome
Kahn and Ginsberg
Arch Intern Med 2004;164:17-26.
ABSTRACT
| FULL TEXT
How we diagnose and treat deep vein thrombosis
Hirsh and Lee
Blood 2002;99:3102-3110.
ABSTRACT
| FULL TEXT
|
