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Original Research: ANTITHROMBOTIC THERAPY |

Pharmacologic and Compression Therapies for Postthrombotic SyndromeTherapies for Postthrombotic Syndrome: A Systematic Review of Randomized Controlled Trials

Jacqueline M. Cohen, BA⪼ Elie A. Akl, MD, PhD, MPH; Susan R. Kahn, MD
Author and Funding Information

From the Department of Epidemiology, Biostatistics and Occupational Health (Ms Cohen and Dr Kahn), and the Division of Internal Medicine (Dr Kahn), McGill University; Lady Davis Institute for Medical Research (Dr Kahn), Jewish General Hospital, Montreal, QC, Canada; the Department of Clinical Epidemiology and Biostatistics (Dr Akl), McMaster University, Hamilton, ON, Canada; and the Department of Medicine (Dr Akl), State University of New York at Buffalo, Buffalo, NY.

Correspondence to: Susan R. Kahn, MD, McGill University, Division of Internal Medicine, and Center for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Ste Catherine, Room H-420.1, Montreal, QC, H3T 1E2, Canada; e-mail: susan.kahn@mcgill.ca


Funding/Support: Dr Kahn is supported by a National Investigator (chercheur national) award of the Fonds de la recherche en santé du Québec (FRSQ). Ms Cohen receives a doctoral training award from the FRSQ.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(2):308-320. doi:10.1378/chest.11-1175
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Background:  Postthrombotic syndrome (PTS) is a frequent, chronic complication of DVT. The effectiveness and safety of available treatments are unknown. The objective of this study was to systematically review the literature to assess whether pharmacologic and compression therapies are effective and safe for the treatment of PTS.

Methods:  We sought to identify randomized controlled trials (RCTs) via a search of PubMed, studies referenced in included publications, and studies that cited relevant literature.

Results:  A total of 121 titles were reviewed, 12 full-text publications were assessed for inclusion, and seven RCTs, including 703 patients, were selected for inclusion. Four trials assessed the effectiveness of drugs, including rutosides, hidrosmin, and defibrotide, and four trials assessed compression therapies for treatment of PTS. Systems for the diagnosis and classification of PTS severity varied across studies. Three of four drug therapy trials reported moderate improvement in selected PTS symptoms, minor changes in calf and ankle circumference, and some effects on ulcer healing. Two studies of compression stockings did not report benefit. Two studies that assessed compression devices reported improvement in PTS symptoms scores; one of these reported an improvement in quality-of-life score.

Conclusions:  There is limited and low-quality evidence for the effectiveness of rutosides, hidrosmin, defibrotide, and compression stockings, but moderate-quality evidence that supports the use of intermittent compression to provide at least short-term relief from PTS. More rigorous studies are needed to assess the short- and long-term effectiveness and safety of PTS therapies.

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