Noticias

Noticias

  • Título: Preventing post-thrombotic syndrome in the 21st Century: Abandon routine use of compression stockings by Dr. Frank Criado
  • Fecha: 01-03-2016

  • Frank J Criado, MD, FACS, FSVM


    According to the updated guidelines concerning treatment of patients with venous thromboembolism (American College of Chest Physicians’ 10th edition of “Antithrombotic Therapy for VTE Disease”, Chest. 2015. doi: 10.1016/j.chest.2015.11.026), routine use of compression stockings for prevention of post-thrombotic syndrome should be abandoned.

    Two other key changes relate to new treatment recommendations about which patients with isolated sub-segmental pulmonary embolism (PE) should, and should not, receive anticoagulant therapy, and a recommendation for the use of non–vitamin K antagonist oral anticoagulants (NOACs) instead of warfarin for initial and long-term treatment of VTE in patients without cancer. This is another of the group’s living guidelines meant to be flexible and easy to update, and based on the best available evidence.

    The old recommendation to use graduated compression stockings for 2 years after DVT to reduce the risk of post-thrombotic syndrome was mainly based on findings of two small single-center randomized trials in which patients and study personnel were not blinded to stocking use. Since then, a much larger multicenter placebo-controlled study found that routine use of graduated compression stockings did not reduce post-thrombotic syndrome or have any other important significant benefit. The incidence of

    post-thrombotic syndrome was 14% in the active group and 13% in the placebo group – a nonsignificant difference. The same study also found that routine use of graduated compression stockings did not reduce leg pain during the 3 months after a DVT – although the stockings were still able to reduce acute symptoms of DVT, and chronic symptoms in patients with post-thrombotic syndrome.

    The recommendation to replace warfarin with NOACs is based on new data suggesting that the new agents are associated with a lower risk of bleeding, and on observations that NOACs are more user-friendly both for patients and physicians. There are also now extensive data on the comparative safety of NOACs and warfarin.



  • Fuente: endovascular.es