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Gerard Stansby - One of the best experts on this subject based on the ideXlab platform.

  • combined intermittent pneumatic Leg Compression and pharmacological prophylaxis for prevention of venous thromboembolism
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Stavros K Kakkos, Gerard Stansby, Joseph A Caprini, George Geroulakos, A N Nicolaides, Daniel J Reddy, Ioannis Ntouvas
    Abstract:

    Background It is generally assumed by practitioners and guideline authors that combined modalities (methods of treatment) are more effective than single modalities in preventing venous thromboembolism (VTE), defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), or both. This is an update of the review first published in 2008. Objectives The aim of this review was to assess the efficacy of combined intermittent pneumatic Leg Compression (IPC) and pharmacological prophylaxis versus single modalities in preventing venous thromboembolism. Search methods For this update the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (May 2016). In addition the CIS searched the Cochrane Register of Studies (CENTRAL (2016, Issue 4)). Clinical trials databases were searched for details of ongoing or unpublished studies. Selection criteria Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) of combined IPC and pharmacological interventions used to prevent VTE. Data collection and analysis We independently selected trials and extracted data. Disagreements were resolved by discussion. We performed fixed-effect model meta-analyses with odds ratios (ORs) and 95% confidence intervals (CIs). We used a random-effects model when there was heterogeneity. Main results We included a total of 22 trials (9137 participants) of which 15 were randomized trials (7762 participants). The overall risk of bias was mostly unclear or high due to selection and performance bias. We used GRADE to assess the quality of the evidence and this was downgraded from high to moderate or very low due to the risk of bias, imprecision or indirectness. The rate of PE in the studies comparing IPC alone with combined IPC and pharmacological prophylaxis was low, underpowering the analyses. The incidence of symptomatic PE was 0.79% with IPC, but ranged between 0.1 to 1% with combined IPC and pharmacological prophylaxis (OR 0.49, 95% CI 0.18 to 1.34; 12 studies, 3017 participants, moderate quality evidence). The incidence of DVT was 4.10% in the IPC group and 2.19% in the combined group showing a reduced incidence of DVT in favour of the combined group (OR 0.52, 95% CI 0.33 to 0.82; 11 studies, 2934 participants, moderate quality evidence). The addition of an anticoagulant to IPC, however, increased the risk of any bleeding compared to IPC alone; 0.66% (7/1053) in the IPC group and 4.0% (44/1102) in the combined group (OR 5.04, 95% CI 2.36 to 10.77; 7 studies, 2155 participants, moderate quality evidence). Major bleeding followed a similar pattern; 0.1% (1/1053) in the IPC group to 1.5% (17/1102) in the combined group (OR 6.81, 95% CI 1.99 to 23.28; 7 studies, 2155 participants, moderate quality evidence). We detected no difference between the type of surgery subgroups such as orthopedic and non-orthopedic participants for DVT incidence (P = 0.16). Tests for differences between type of surgery subgroups were not possible for PE incidence. Compared with pharmacological prophylaxis alone, the use of combined IPC and pharmacological prophylaxis modalities reduced the incidence of symptomatic PE from 2.92% to 1.20% (OR 0.39, 95% CI 0.23 to 0.64; 10 studies, 3544 participants, moderate quality evidence). The incidence of DVT was 6.2% in the pharmacological prophylaxis group and 2.9% in the combined group showing no difference between the combined and pharmacological prophylaxis groups (OR 0.42, 95% CI 0.18 to 1.03; 11 studies, 2866 participants, moderate quality evidence). Increased bleeding side effects were not observed for IPC when it was added to anticoagulation (bleeding: OR 0.80, 95% CI 0.30 to 2.14, very low quality evidence; major bleeding: OR 1.21, 95% CI 0.35 to 4.18, very low quality evidence, 3 studies, 244 participants). No difference was detected between the type of surgery subgroups for PE incidence (P = 0.68) or for DVT incidence (P = 0.10). Authors' conclusions Moderate quality evidence suggests that combining IPC and pharmacological prophylaxis, compared with IPC or pharmacological prophylaxis alone, decreases the incidence of DVT when compared to Compression, and incidence of PE when compared to anticoagulation. Moderate quality evidence suggests that there is no difference between combined and single modalities in the incidence of PE when compared with Compression alone and DVT when compared with anticoagulation alone. The quality of evidence for PE or DVT was downgraded to moderate due to imprecision or risk of bias in study methodology, highlighting the need for further research. Moderate quality evidence suggests the addition of pharmacological prophylaxis to IPC, increased the risk of bleeding compared to IPC alone, a side effect not observed for IPC when added to pharmacological prophylaxis (very low quality evidence), as expected for a physical method of thromboprophylaxis. The quality of evidence for bleeding was downgraded to moderate due to indirectness or very low due to risk of bias in study methodology, indirectness and imprecision highlighting the need for further research. Nevertheless, the results of the current review agree with current guideline recommendations, which support the use of combined modalities in hospitalised patients (limited to those with trauma or undergoing surgery) at risk of developing VTE. More studies on the role of combined modalities in VTE prevention are needed.

  • combined intermittent pneumatic Leg Compression and pharmacological prophylaxis for prevention of venous thrombo embolism in high risk patients
    European Journal of Vascular and Endovascular Surgery, 2009
    Co-Authors: Stavros K Kakkos, Gerard Stansby, Joseph A Caprini, George Geroulakos, A N Nicolaides, Daniel J Reddy
    Abstract:

    BACKGROUND: It has been suggested that combined modalities (methods of treatment) are more effective than single modalities in preventing venous thrombo-embolism (defined as deep vein thrombosis and pulmonary embolism, or both) in high-risk patients. OBJECTIVES: To assess the efficacy of intermittent pneumatic Leg Compression combined with pharmacological prophylaxis versus single modalities in preventing venous thrombo-embolism in high-risk patients. SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases (PVD) Group searched the reference lists of their Specialised Register (last searched 17 July 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched The Cochrane Library 2008, issue 3) for relevant articles to identify additional trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) of combined intermittent pneumatic Leg Compression and pharmacological interventions used to prevent venous thrombo-embolism in high-risk patients. DATA COLLECTION AND ANALYSIS: Data extraction was undertaken independently by two review authors using data extraction sheets.

  • combined intermittent pneumatic Leg Compression and pharmacological prophylaxis for prevention of venous thromboembolism in high risk patients
    Cochrane Database of Systematic Reviews, 2008
    Co-Authors: Stavros K Kakkos, Gerard Stansby, Joseph A Caprini, George Geroulakos, A N Nicolaides, Daniel J Reddy
    Abstract:

    Background It has been suggested that combined modalities (methods of treatment) are more effective than single modalities in preventing venous thromboembolism (defined as deep vein thrombosis and pulmonary embolism, or both) in high-risk patients. Objectives To assess the efficacy of intermittent pneumatic Leg Compression combined with pharmacological prophylaxis versus single modalities in preventing venous thromboembolism in high-risk patients. Search methods The Cochrane Peripheral Vascular Diseases (PVD) Group searched their Specialized Register (last searched 17 July 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched The Cochrane Library 2008, Issue 3). We searched the reference lists of relevant articles to identify additional trials. Selection criteria Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) of combined intermittent pneumatic Leg Compression and pharmacological interventions used to prevent venous thromboembolism in high-risk patients. Data collection and analysis Data extraction was undertaken independently by two review authors using data extraction sheets. Main results Eleven studies, six of them randomized controlled trials, were identified. The trials included 7431 patients, in total. Compared with Compression alone, the use of combined modalities reduced significantly the incidence of both symptomatic pulmonary embolism (PE) (from about 3% to 1%; odds ratio (OR) 0.39, 95% confidence interval (CI) 0.25 to 0.63) and deep vein thrombosis (DVT) (from about 4% to 1%; OR 0.43, 95% CI 0.24 to 0.76). Compared with pharmacological prophylaxis alone, the use of combined modalities significantly reduced the incidence of DVT (from 4.21% to 0.65%; OR 0.16, 95% CI 0.07 to 0.34) but the included studies were underpowered with regard to PE. The comparison of Compression plus pharmacological prophylaxis versus Compression plus aspirin showed a non-significant reduction in PE and DVT in favor of the former group. Repeat analysis restricted to the RCTs confirmed the above findings. Authors' conclusions Compared with Compression alone, combined prophylactic modalities decrease significantly the incidence of venous thromboembolism. Compared with pharmacological prophylaxis alone, combined modalities reduce significantly the incidence of DVT but the effect on PE is unknown. The results of the current review support, especially in high-risk patients, the use of combined modalities. More studies on their role in PE prevention, compared with pharmacological prophylaxis alone, are urgently needed.

  • improving walking ability and ankle brachial pressure indices in symptomatic peripheral vascular disease with intermittent pneumatic foot Compression a prospective controlled study with one year follow up
    Journal of Vascular Surgery, 2000
    Co-Authors: Konstantinos T Delis, J H N Wolfe, Andrew N. Nicolaides, Gerard Stansby
    Abstract:

    PURPOSE: Intermittent pneumatic foot Compression (IPC(foot)) augments arterial Leg inflow. It has been suggested that prolonged use of impulse Leg Compression at home might ameliorate claudication caused by peripheral vascular disease by improving collateral circulation. The purpose of this study was to determine the effect of IPC(foot) treatment on claudication distance and arterial hemodynamics in patients with intermittent claudication caused by peripheral vascular disease. METHODS: Thirty-seven patients with stable intermittent claudication were admitted to this prospective controlled study. Of these, 25 patients received IPC(foot) (>4 hr/d) for 4.5 months (group 1), and the other 12 patients acted as control patients (group 2). Both groups were advised to exercise unsupervised for a minimum of 1 hour daily and received aspirin (75 mg/d). Groups were matched for age, sex, risk factors, claudication distances, and ankle pressures at baseline. In each patient, initial claudication distance (ICD), absolute claudication distance (ACD), resting ankle brachial index (r-ABI), ankle brachial pressure index after exercise (p-eABI), and popliteal artery volume flow were measured at day 0, 2 weeks, and 1, 2, 3, and 4.5 months. On completion of the treatment period (4.5 months), both groups continued with aspirin (75 mg/d) and unsupervised exercise and were re-examined after 12 months. Data analysis is based on nonparametric statistics, the Wilcoxon signed ranks test, and the Mann-Whitney test for intragroup and intergroup comparisons, respectively. Results are expressed as median and interquartile ranges. RESULTS: Over the 4.5 months of active treatment, (1) median ICD in group 1 increased by 146% (P <.001), from 78 m (interquartile range, 65-102 m) at baseline to 191.5 m (interquartile range, 127-254 m); ICD did not significantly increase in group 2; (2) median ACD in group 1 improved by 106% (P <.001), from 124 m (interquartile range, 100-160 m) to 255 m (interquartile range, 149-398 m); no significant changes were documented in group 2; (3) median r-ABI in group 1 rose by 18% (P <.001), from 0.57 (interquartile range, 0.48-0.62) to 0.67 (interquartile range, 0.64-0.70); no improvement was noted in group 2; (4) median p-eABI in group 1 rose by 110% (P <.001), from 0.21 (interquartile range, 0.07-0.27) to 0.44 (interquartile range, 0. 36-0.52); no changes were noted in group 2; and (5) median popliteal artery volume flow in group 1 improved by 36% (P <.001), from 100 mL/min (interquartile range, 59-163 mL/min) to 136 mL/min (interquartile range, 99.5-173.4 mL/min); no significant changes were found in group 2. At 4.5 months, ICD, ACD, r-ABI, and p-eABI in group 1 were all significantly better than those in group 2 (P <.01). Twelve months' posttreatment, walking ability and ABIs in group 1 were not statistically different from those at 4.5 months and remained significantly better than those of control subjects. CONCLUSION: Intermittent pneumatic foot Compression used at home for 4.5 months increases claudication distance by over 100%. Associated increases in r-ABI by 18%, p-eABI by 110%, and arterial calf inflow by 36% suggest an improved collateral circulation. Maximum benefit seems to be offered over the initial 3 months. Treatment benefits are maintained 1 year after treatment. A multicenter study is indicated to quantify actual benefits and to demonstrate cost effectiveness.

  • Improving walking ability and ankle brachial pressure indices in symptomatic peripheral vascular disease with intermittent pneumatic foot Compression: A prospective controlled study with one-year follow-up
    Journal of Vascular Surgery, 2000
    Co-Authors: Konstantinos T Delis, J H N Wolfe, Andrew N. Nicolaides, Gerard Stansby
    Abstract:

    PURPOSE: Intermittent pneumatic foot Compression (IPC(foot)) augments arterial Leg inflow. It has been suggested that prolonged use of impulse Leg Compression at home might ameliorate claudication caused by peripheral vascular disease by improving collateral circulation. The purpose of this study was to determine the effect of IPC(foot) treatment on claudication distance and arterial hemodynamics in patients with intermittent claudication caused by peripheral vascular disease. METHODS: Thirty-seven patients with stable intermittent claudication were admitted to this prospective controlled study. Of these, 25 patients received IPC(foot) (>4 hr/d) for 4.5 months (group 1), and the other 12 patients acted as control patients (group 2). Both groups were advised to exercise unsupervised for a minimum of 1 hour daily and received aspirin (75 mg/d). Groups were matched for age, sex, risk factors, claudication distances, and ankle pressures at baseline. In each patient, initial claudication distance (ICD), absolute claudication distance (ACD), resting ankle brachial index (r-ABI), ankle brachial pressure index after exercise (p-eABI), and popliteal artery volume flow were measured at day 0, 2 weeks, and 1, 2, 3, and 4.5 months. On completion of the treatment period (4.5 months), both groups continued with aspirin (75 mg/d) and unsupervised exercise and were re-examined after 12 months. Data analysis is based on nonparametric statistics, the Wilcoxon signed ranks test, and the Mann-Whitney test for intragroup and intergroup comparisons, respectively. Results are expressed as median and interquartile ranges. RESULTS: Over the 4.5 months of active treatment, (1) median ICD in group 1 increased by 146% (P

Konstantinos T Delis - One of the best experts on this subject based on the ideXlab platform.

  • duration and amplitude decay of acute arterial Leg inflow enhancement with intermittent pneumatic Leg Compression an insight into the implicated physiologic mechanisms
    Journal of Vascular Surgery, 2005
    Co-Authors: Konstantinos T Delis, Alison L Knaggs
    Abstract:

    Purpose By acutely enhancing the arterial Leg inflow, intermittent pneumatic Leg Compression (IPC) improves the walking ability, arterial hemodynamics, and quality of life of claudicants. We quantified the duration of acute Leg inflow enhancement with IPC of the foot (IPC foot ), calf (IPC calf ), or both (IPC foot+calf ) and its amplitude decay in claudicants and controls in relation to the pulsatility index, an estimate of peripheral resistance. These findings are cross-correlated with the features of the three implicated physiologic mechanisms: (1) an increase in the arteriovenous pressure gradient, (2) suspension of peripheral sympathetic autoregulation, and (3) enhanced release of nitric oxide with flow and shear-stress increase. Methods Twenty-six limbs of 24 claudicants with superficial femoral artery occlusion or stenoses (>75%) and 24 limbs of 20 healthy controls matched for age and sex, meeting stringent selection criteria, had their popliteal volume flow and pulsating index (peak-to-peak velocity/mean velocity) measured with duplex scanning at rest and upon delivery of IPC. Spectral waveforms were analyzed for 50 seconds after IPC delivery per 5-second segments. The three IPC modes were applied in a true crossover design. Data analysis was performed with the Page, Friedman, Wilcoxon, Mann-Whitney and χ 2 tests. Results The median duration of flow enhancement in claudicants exceeded 50 seconds with IPC foot , IPC calf , and IPC foot+calf but was shorter ( P P foot and IPC foot+calf . After reaching its peak within 5 seconds of IPC, flow enhancement decayed at rates decreasing over time (trend, P P foot , 37.5 seconds with IPC calf , and 40 seconds with IPC foot+calf ; duration of pulsatility index attenuation was shorter in the control limbs with IPC foot (30 seconds), IPC calf (32.5 seconds), or IPC foot+calf (35 seconds), yet differences, as well as those among the 3 IPC modes, were not significant. Conclusion Leg inflow enhancement with IPC exceeds 50 seconds in claudicants and lasts 32.5 to 40 seconds in the controls. Peak flow occurs concurrently with maximal pulsatility index attenuation, within 5 seconds of IPC. Irrespective of group or IPC mode, the decay rate (%) of flow enhancement is highest within 5 to 20 seconds of IPC, moderate at 20 to 35 seconds, and lowest at 35 to 50 seconds. Since attenuation in peripheral resistance terminates with the mid time period (20 to 35 seconds) of flow decay, and nitric oxide has a half-life of

  • enhancing foot skin blood flux in peripheral vascular disease using intermittent pneumatic Compression controlled study on claudicants and grafted arteriopaths
    World Journal of Surgery, 2002
    Co-Authors: Konstantinos T Delis, A N Nicolaides, Mark J W Husmann, J H N Wolfe, N J W Cheshire
    Abstract:

    Intermittent pneumatic Leg Compression (IPC) increases arterial calf inflow and foot skin blood flux in normal subjects and claudicants. Our hypothesis was that IPC could enhance foot skin blood flux after infrainguinal grafting and thus promote distal perfusion in limbs with tissue loss. The aim of this study was to compare the effects of three IPC modes [applied to the foot (IPCfoot), the calf (IPCcalf), or both (IPCfoot+calf)] on foot skin perfusion in healthy individuals, claudicants, and patients after infrainguinal arterial revascularization performed for critical or subcritical limb ischemia. Altogether, 20 healthy limbs, 22 claudicating limbs, and 36 limbs of arteriopaths with prior successful autologous femoropopliteal and femorodistal (18 each) grafts were examined. Five-minute laser Doppler recordings were obtained from the pulp of the big toe in the sitting position, at rest, and during random applications of IPCfoot, IPCcalf, and IPCfoot+calf delivered at 120 mmHg for 4 seconds three times per minute. Foot skin blood flux increased using all IPC modes (p <0.001), with IPCfoot and IPCfoot+calf generating higher flux levels than IPCcalf (p <0.01) in all groups. Intergroup differences of flux with each of the three IPC modes were not significant. IPCfoot and IPCfoot+calf similarly (p > 0.14) produced a higher percentage flux increase than IPCcalf in all groups (p <0.004). Controls had a higher percentage flux increase with both IPCcalf and IPCfoot than did claudicants (p ≤ 0.016). No differences were documented between normal and grafted limbs (p > 0.05). The percentage flux increase with IPCfoot+calf and IPCcalf was significantly higher in femorodistal grafts than in femoropopliteal ones (p ≤ 0.026). IPC enhances skin blood flux in limbs with infrainguinal bypass, claudication, and normal arteries, with IPCfoot and IPCfoot+calf being more effective than IPCcalf. Our findings suggest that IPC may be beneficial in limbs with impaired distal perfusion and thus may have clinical implications in the treatment of Leg ulcers either prior to or after revascularization.

  • improving walking ability and ankle brachial pressure indices in symptomatic peripheral vascular disease with intermittent pneumatic foot Compression a prospective controlled study with one year follow up
    Journal of Vascular Surgery, 2000
    Co-Authors: Konstantinos T Delis, J H N Wolfe, Andrew N. Nicolaides, Gerard Stansby
    Abstract:

    PURPOSE: Intermittent pneumatic foot Compression (IPC(foot)) augments arterial Leg inflow. It has been suggested that prolonged use of impulse Leg Compression at home might ameliorate claudication caused by peripheral vascular disease by improving collateral circulation. The purpose of this study was to determine the effect of IPC(foot) treatment on claudication distance and arterial hemodynamics in patients with intermittent claudication caused by peripheral vascular disease. METHODS: Thirty-seven patients with stable intermittent claudication were admitted to this prospective controlled study. Of these, 25 patients received IPC(foot) (>4 hr/d) for 4.5 months (group 1), and the other 12 patients acted as control patients (group 2). Both groups were advised to exercise unsupervised for a minimum of 1 hour daily and received aspirin (75 mg/d). Groups were matched for age, sex, risk factors, claudication distances, and ankle pressures at baseline. In each patient, initial claudication distance (ICD), absolute claudication distance (ACD), resting ankle brachial index (r-ABI), ankle brachial pressure index after exercise (p-eABI), and popliteal artery volume flow were measured at day 0, 2 weeks, and 1, 2, 3, and 4.5 months. On completion of the treatment period (4.5 months), both groups continued with aspirin (75 mg/d) and unsupervised exercise and were re-examined after 12 months. Data analysis is based on nonparametric statistics, the Wilcoxon signed ranks test, and the Mann-Whitney test for intragroup and intergroup comparisons, respectively. Results are expressed as median and interquartile ranges. RESULTS: Over the 4.5 months of active treatment, (1) median ICD in group 1 increased by 146% (P <.001), from 78 m (interquartile range, 65-102 m) at baseline to 191.5 m (interquartile range, 127-254 m); ICD did not significantly increase in group 2; (2) median ACD in group 1 improved by 106% (P <.001), from 124 m (interquartile range, 100-160 m) to 255 m (interquartile range, 149-398 m); no significant changes were documented in group 2; (3) median r-ABI in group 1 rose by 18% (P <.001), from 0.57 (interquartile range, 0.48-0.62) to 0.67 (interquartile range, 0.64-0.70); no improvement was noted in group 2; (4) median p-eABI in group 1 rose by 110% (P <.001), from 0.21 (interquartile range, 0.07-0.27) to 0.44 (interquartile range, 0. 36-0.52); no changes were noted in group 2; and (5) median popliteal artery volume flow in group 1 improved by 36% (P <.001), from 100 mL/min (interquartile range, 59-163 mL/min) to 136 mL/min (interquartile range, 99.5-173.4 mL/min); no significant changes were found in group 2. At 4.5 months, ICD, ACD, r-ABI, and p-eABI in group 1 were all significantly better than those in group 2 (P <.01). Twelve months' posttreatment, walking ability and ABIs in group 1 were not statistically different from those at 4.5 months and remained significantly better than those of control subjects. CONCLUSION: Intermittent pneumatic foot Compression used at home for 4.5 months increases claudication distance by over 100%. Associated increases in r-ABI by 18%, p-eABI by 110%, and arterial calf inflow by 36% suggest an improved collateral circulation. Maximum benefit seems to be offered over the initial 3 months. Treatment benefits are maintained 1 year after treatment. A multicenter study is indicated to quantify actual benefits and to demonstrate cost effectiveness.

  • Improving walking ability and ankle brachial pressure indices in symptomatic peripheral vascular disease with intermittent pneumatic foot Compression: A prospective controlled study with one-year follow-up
    Journal of Vascular Surgery, 2000
    Co-Authors: Konstantinos T Delis, J H N Wolfe, Andrew N. Nicolaides, Gerard Stansby
    Abstract:

    PURPOSE: Intermittent pneumatic foot Compression (IPC(foot)) augments arterial Leg inflow. It has been suggested that prolonged use of impulse Leg Compression at home might ameliorate claudication caused by peripheral vascular disease by improving collateral circulation. The purpose of this study was to determine the effect of IPC(foot) treatment on claudication distance and arterial hemodynamics in patients with intermittent claudication caused by peripheral vascular disease. METHODS: Thirty-seven patients with stable intermittent claudication were admitted to this prospective controlled study. Of these, 25 patients received IPC(foot) (>4 hr/d) for 4.5 months (group 1), and the other 12 patients acted as control patients (group 2). Both groups were advised to exercise unsupervised for a minimum of 1 hour daily and received aspirin (75 mg/d). Groups were matched for age, sex, risk factors, claudication distances, and ankle pressures at baseline. In each patient, initial claudication distance (ICD), absolute claudication distance (ACD), resting ankle brachial index (r-ABI), ankle brachial pressure index after exercise (p-eABI), and popliteal artery volume flow were measured at day 0, 2 weeks, and 1, 2, 3, and 4.5 months. On completion of the treatment period (4.5 months), both groups continued with aspirin (75 mg/d) and unsupervised exercise and were re-examined after 12 months. Data analysis is based on nonparametric statistics, the Wilcoxon signed ranks test, and the Mann-Whitney test for intragroup and intergroup comparisons, respectively. Results are expressed as median and interquartile ranges. RESULTS: Over the 4.5 months of active treatment, (1) median ICD in group 1 increased by 146% (P

H Partsch - One of the best experts on this subject based on the ideXlab platform.

  • the role of Leg Compression in the treatment of deep vein thrombosis
    Phlebology, 2014
    Co-Authors: H Partsch
    Abstract:

    Up until today mobile outpatients are put into bed as soon as the diagnosis of deep vein thrombosis (DVT) is made. Fear of pulmonary embolism (PE) is the main rationale for bed-rest; additional arg...

  • measurement of lower Leg Compression in vivo recommendations for the performance of measurements of interface pressure and stiffness
    Dermatologic Surgery, 2006
    Co-Authors: H Partsch, Joseph A Caprini, Michael Clark, Sophie Bassez, Jeanpatrick Benigni, Francois Becker, Vladimir Blazek, Andre Cornuthenard, Jurg Hafner, Mieke Flour
    Abstract:

    BACKGROUND: Interface pressure and stiffness characterizing the elastic properties of the material are the parameters determining the dosage of Compression treatment and should therefore be measured in future clinical trials. OBJECTIVE: To provide some recommendations regarding the use of suitable methods for this indication. METHOD: This article was formulated based on the results of an international consensus meeting between a group of medical experts and representatives from the industry held in January 2005 in Vienna, Austria. RESULTS: Proposals are made concerning methods for measuring the interface pressure and for assessing the stiffness of a Compression device in an individual patient. CONCLUSIONS: In vivo measurement of interface pressure is encouraged when clinical and experimental outcomes of Compression treatment are to be evaluated.

  • measurement of lower Leg Compression in vivo recommendations for the performance of measurements of interface pressure and stiffness
    Dermatologic Surgery, 2006
    Co-Authors: H Partsch, Joseph A Caprini, Michael Clark, Sophie Bassez, Jeanpatrick Benigni, Francois Becker, Vladimir Blazek, Andre Cornuthenard, Jurg Hafner, Mieke Flour
    Abstract:

    ,MDMembers of the International Committee who agreed with the consensus statement:M Abel, Germany; I Achhammer, France; A Andriessen, the Netherlands; C Belczak,Brazil; D Bender, USA; E Brizzio, Argentina; ER Brouwer, the Netherlands;A Cavezzi, Italy; H Charles, UK; RJ Damstra, the Netherlands; W Doeller, Austria;D Foster, UK; J Hutchinson, UK; J Juge, France; N Kecelj, Slovenia; G Langen,Germany; J Leal Monedero, Spain; V Mattaliano, Italy; U Meyer, Germany; JMMollard, France; G Mosti, Italy; E Rabe, Germany; AA Ramelet, Switzerland; ChRohrer, Austria; J Schuren, Germany; E Serra-Brandao, Portugal; JF Uhl, France; KVan der Wegen, the Netherlands; W Vanscheidt, Germany; and N Velazquez, Spain.

  • immediate ambulation and Leg Compression in the treatment of deep vein thrombosis
    Dm Disease-a-month, 2005
    Co-Authors: H Partsch
    Abstract:

    he introduction of subcutaneous injections of low molecular weight eparin (LMWH) instead of intravenous infusions with unfractionated eparin (UFH) allowed one to recommend home treatment of patients ith deep-vein thrombosis (DVT). However, the practically important question of when and how intenively these patients can ambulate is not addressed in DVT studies and eta-analyses advocating home therapy, nor in most recommendations nd patients’ brochures. Until recently it was also not clear if adjuvant ompression therapy is of any beneficial value in the acute stage of DVT.

  • Leg Compression and ambulation is better than bed rest for the treatment of acute deep venous thrombosis
    International Angiology, 2003
    Co-Authors: W Blattler, H Partsch
    Abstract:

    Aim. Treatment of acute deep venous thrombosis (DVT) with low-molecular-weight heparin and vitamin K-antagonists reduces the risk of thrombus progression and pulmonary embolism but has no immediate effect on signs and symptoms. We addressed the question whether adding Compression and walking would lead to a more rapid clinical improvement than bed rest. Methods. Fifty-three symptomatic outpatients with proximal DVT were randomly treated, in addition to dalteparin and phenprocoumon, with either firm inelastic bandages (n=18), elastic Compression stockings (n=18), both combined with immediate deliberate ambulation, or bed rest without any Compression (n=17). We assessed daily walking distance, well-being, quality of life, pain, swelling and clinical scores over a period of 9 days. Lung scans and ultrasound of the Leg were performed on days 0 and 9. Results. In the Compression groups the walking distance increased with time to 4 km/day on average. Improvement of well-being and DVT-related quality of life was significantly faster and more pronounced with Compression than with bed rest (p<0.05 for stockings, p<0.001 for bandages). Pain monitored by visual analogue scale decreased with time in a linear pattern in all groups (p<0.001). There was a significant difference between the groups (p<0.01), the best effect being achieved with bandages. Pain assessed by a provocation test was reduced by half on day 3 with bed rest but remained constantly present over the subsequent 6 days. With Compression it was reduced to near baseline on day 3. Swelling was almost completely removed with Compression and clinical scores also improved more than with bed rest (p<0.001). Thrombus progression, as studied with ultrasound, was less frequent and less pronounced in the Compression groups than with bed rests There was no difference of new pulmonary embolism on repeat lung scans. Conclusion. Leg Compression combined with walking is the better alternative to bed rest for the treatment of symptomatic outpatients with proximal DVT.

Werner Blättler - One of the best experts on this subject based on the ideXlab platform.

  • in search of optimal Compression therapy for venous Leg ulcers a meta analysis of studies comparing divers bandages with specifically designed stockings
    Journal of Vascular Surgery, 2009
    Co-Authors: Felix Amsler, Werner Blättler, Torsten Willenberg
    Abstract:

    Objective In search of an optimal Compression therapy for venous Leg ulcers, a systematic review and meta-analysis was performed of randomized controlled trials (RCT) comparing Compression systems based on stockings (MCS) with divers bandages. Methods RCT were retrieved from six sources and reviewed independently. The primary endpoint, completion of healing within a defined time frame, and the secondary endpoints, time to healing, and pain were entered into a meta-analysis using the tools of the Cochrane Collaboration. Additional subjective endpoints were summarized. Results Eight RCT (published 1985-2008) fulfilled the predefined criteria. Data presentation was adequate and showed moderate heterogeneity. The studies included 692 patients (21-178/study, mean age 61 years, 56% women). Analyzed were 688 ulcerated Legs, present for 1 week to 9 years, sizing 1 to 210 cm 2 . The observation period ranged from 12 to 78 weeks. Patient and ulcer characteristics were evenly distributed in three studies, favored the stocking groups in four, and the bandage group in one. Data on the pressure exerted by stockings and bandages were reported in seven and two studies, amounting to 31-56 and 27-49 mm Hg, respectively. The proportion of ulcers healed was greater with stockings than with bandages (62.7% vs 46.6%; P P = .0002). In no study performed bandages better than MCS. Pain was assessed in three studies (219 patients) revealing an important advantage of stockings ( P Conclusions Leg Compression with stockings is clearly better than Compression with bandages, has a positive impact on pain, and is easier to use.

  • Compression therapy for occupational Leg symptoms and chronic venous disorders a meta analysis of randomised controlled trials
    European Journal of Vascular and Endovascular Surgery, 2008
    Co-Authors: Felix Amsler, Werner Blättler
    Abstract:

    Objective. Leg discomfort and oedema are commonly attributed to a venous disorder (CVD) or chronic venous insufficiency (CVI) and treated with Compression hosiery. The pressure needed to achieve clinical benefit is a matter of debate. Design. We performed a meta-analysis of randomised controlled trials (RCT) that compared stockings exerting an ankle pressure of 10e20 mmHg with placebo or no treatment and with stockings exerting a pressure of more than 20 mmHg. Methods. RCT were retrieved and analysed with the tools of the Cochrane Collaboration. Each study was reviewed independently. Subjective dichotomous and continuous factors and objective findings were pooled for statistical treatment. Results. Eleven RCT fulfilled the predefined criteria. They included 1453 randomised subjects, 794 healthy people exposed to various forms of stress, 552 patients with a chronic venous disorder or chronic venous insufficiency and 141 patients after varicose vein surgery. Over all, Compression with 10e20 mmHg had a clear effect on oedema and symptoms as compared with 20 mmHg stockings. Conclusions. Despite important methodological heterogeneity and sometimes sub-standard reporting the meta-analysis suggests that Leg Compression with 10e15 mmHg is an effective treatment for CVD. Less pressure is ineffective and higher pressure may be of no additional benefit. 2007 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  • Combined regional thrombolysis and surgical thrombectomy for treatment of iliofemoral vein thrombosis.
    Journal of vascular surgery, 2004
    Co-Authors: Werner Blättler, G. Heller, Jon Largiadèr, Hannu Savolainen, Beat Gloor, Jürg Schmidli
    Abstract:

    Objective In at least half of patients with iliofemoral deep vein thrombosis post-thrombotic syndrome develops when only anticoagulant therapy is given. We combined thrombolysis, applied under ischemic conditions,with surgical thrombectomy to restore patencyand valve function. The technique and the short-term and long-term results in 2 patient series are reported. Methods A catheter was inserted into a foot vein of the thrombosed Leg, and the limb was excluded from the circulation with a pneumatic cuff placed on the thigh with the patient under general anesthesia. Urokinase (0.5 million–3 million IU) and heparin were infused and allowed to act for 30 minutes while the pelvic axis was cleared with a Fogarty catheter through an inguinal venotomy. The external iliac vein was then clamped and the cuff removed. Thrombi that detached from the wall were flushed out with reactive hyperemia and squeezed out with manual Leg Compression. The blood was retrieved, washed, and transfused back into the patient. Various additional procedures were performed to secure outflow. Two patient series are reported: 1 with 12 consecutive patients and 1 with 21 patients who were successfully treated 6 to 10 years previously. Follow-up data were obtained for all patients after 1 year and for 18 of 21 patients after 6 to 10 years. Patency and valve function were assessed with duplex scanning or venography. Studies of blood coagulation and the kinetics of urokinase were performed in 5 additional patients. Results Vein patency and valve function were restored in all consecutive patients. At 1 year none of the 33 patients had had recurrence, and none showed clinical signs of post-thrombotic syndrome. At 6 to 10 years 3 of 18 patients had experienced another venous thromboembolism, but none in the treated Leg. Sixteen Legs were asymptomatic without Compression therapy, and 2 had venous claudication. Coagulation studies showed a trace concentration of urokinase and a mild decrease in fibrinogen in the systemic circulation. The concentration of urokinase in blood collected from the treated Leg was only 1% of that infused. Conclusion Regional thrombolysis combined with surgical thrombectomy is relatively easy to perform and seems safe. Vein patency and valve function were restored, and post-thrombotic syndrome was prevented. Additional procedures to overcome pelvic vein obstructions were required in 11 of 33 patients (33%). The procedure should be tested against standard anticoagulation therapy in patients with acute iliofemoral thrombosis.

James D Douketis - One of the best experts on this subject based on the ideXlab platform.

  • analysis of an algorithm incorporating limited and whole Leg assessment of the deep venous system in symptomatic outpatients with suspected deep vein thrombosis palladio a prospective multicentre cohort study
    The Lancet Haematology, 2015
    Co-Authors: Walter Ageno, James D Douketis, Giuseppe Camporese, Nicoletta Riva, Matteo Iotti, Eugenio Bucherini, Marc Philip Righini, Pieter W Kamphuisen, Peter Verhamme, Chiara Tonello
    Abstract:

    Summary Background Compression ultrasonography is the mainstay of diagnosis of deep-vein thrombosis (DVT) of the Legs. Compression ultrasonography can be extended to the entire deep venous system (whole-Leg) or restricted to the proximal veins only (limited), and the two approaches are clinically equivalent. We aimed to assess the diagnostic value of an algorithm combining whole-Leg and limited Compression ultrasonography. Methods We did a prospective, multicentre, cohort study at eight centres in five countries. Consecutive outpatients aged 18 years or older with suspected DVT underwent D-dimer measurement and pretest clinical probability assessment. DVT was ruled out without further testing if pretest probability was unlikely and D-dimer was negative (group 1). Patients in whom either pretest probability was likely or who were positive for D-dimer underwent limited Compression ultrasonography only (group 2). Finally, patients in whom pretest probability was likely and who had a positive measurement for D-dimer underwent extended whole-Leg Compression ultrasonography (group 3). All patients in whom DVT was ruled out were followed up for 3 months. The primary outcome was the incidence of objectively recorded venous thromboembolism. The primary analysis included all patients managed according to the study protocol. This study is registered with ClinicalTrials.gov, number NCT01412242. The final results are reported here. Findings Between March 1, 2011, and July 31, 2014, 1348 consecutive outpatients were referred for this study, of whom 1162 were eligible to participate. After pretest probability assessment and D-dimer testing, 351 were in group 1, 401 in group 2, and 410 in group 3. Limited Compression ultrasonography was positive in 12 (3%) patients in group 2 and extended whole-Leg Compression ultrasonography was positive in 200 (49%) patients in group 3. 82 (39%) of all DVT diagnosed at baseline were isolated distal thromboses. 26 protocol violations were reported. Thus, 351 patients from group 1, 371 patients in group 2, and 202 patients in group 3 who had been excluded for DVT by the algorithm were included in the primary analysis at 3 months. One, four, and three DVTs were reported, respectively. Thus, the 3-month incidence of venous thromboembolism in untreated patients after a negative diagnostic strategy was 0·87% (95% CI 0·44–1·70). Interpretation An algorithm combining limited and whole-Leg Compression ultrasonography could be a reliable, safe, and convenient method for diagnostic management of outpatients with clinically suspected DVT. Funding None.

  • risk of deep vein thrombosis following a single negative whole Leg Compression ultrasound a systematic review and meta analysis
    JAMA, 2010
    Co-Authors: Stacy A Johnson, Scott M Stevens, Scott C Woller, Erica Lake, Marco P Donadini, Ji Cheng, Jose Labarere, James D Douketis
    Abstract:

    CONTEXT: In patients with suspected lower extremity deep vein thrombosis (DVT), Compression ultrasound (CUS) is typically the initial test to confirm or exclude DVT. Patients with an initial negative CUS result often require repeat CUS after 5 to 7 days. Whole-Leg CUS may exclude proximal and distal DVT in a single evaluation. OBJECTIVE: To determine the risk of venous thromboembolism after withholding anticoagulation in patients with suspected lower extremity DVT following a single negative whole-Leg CUS result. DATA SOURCES: MEDLINE, EMBASE, CINAHL, LILACS, Cochrane, and Health Technology Assessments databases were searched for articles published from January 1970 through November 2009. Supplemental searches were performed of Internet resources, reference lists, and by contacting content experts. STUDY SELECTION: Included studies were randomized controlled trials and prospective cohort studies of patients with suspected DVT and a negative whole-Leg CUS result who did not receive anticoagulant therapy, and were followed up at least 90 days for venous thromboembolism events. DATA EXTRACTION: Two authors independently reviewed and extracted data regarding a single positive or negative whole-Leg CUS result, occurrence of venous thromboembolism during follow-up, and study quality. RESULTS: Seven studies were included totaling 4731 patients with negative whole-Leg CUS examinations who did not receive anticoagulation. Of these, up to 647 patients (13.7%) had active cancer and up to 725 patients (15.3%) recently underwent a major surgery. Most participants were identified from an ambulatory setting. Venous thromboembolism or suspected venous thromboembolism-related death occurred in 34 patients (0.7%), including 11 patients with distal DVT (32.4%); 7 patients with proximal DVT (20.6%); 7 patients with nonfatal pulmonary emboli (20.6%); and 9 patients (26.5%) who died, possibly related to venous thromboembolism. Using a random-effects model with inverse variance weighting, the combined venous thromboembolism event rate at 3 months was 0.57% (95% confidence interval, 0.25%-0.89%). CONCLUSION: Withholding anticoagulation following a single negative whole-Leg CUS result was associated with a low risk of venous thromboembolism during 3-month follow-up.

  • Risk of Deep Vein Thrombosis Following a Single Negative Whole-Leg Compression Ultrasound: A Systematic Review and Meta-analysis.
    Journal of the American Medical Association, 2010
    Co-Authors: Stacy A Johnson, Scott M Stevens, Scott C Woller, Erica Lake, Marco P Donadini, Ji Cheng, Jose Labarere, James D Douketis
    Abstract:

    CONTEXT: In patients with suspected lower extremity deep vein thrombosis (DVT), Compression ultrasound (CUS) is typically the initial test to confirm or exclude DVT. Patients with an initial negative CUS result often require repeat CUS after 5 to 7 days. Whole-Leg CUS may exclude proximal and distal DVT in a single evaluation. OBJECTIVE: To determine the risk of venous thromboembolism after withholding anticoagulation in patients with suspected lower extremity DVT following a single negative whole-Leg CUS result. DATA SOURCES: MEDLINE, EMBASE, CINAHL, LILACS, Cochrane, and Health Technology Assessments databases were searched for articles published from January 1970 through November 2009. Supplemental searches were performed of Internet resources, reference lists, and by contacting content experts. STUDY SELECTION: Included studies were randomized controlled trials and prospective cohort studies of patients with suspected DVT and a negative whole-Leg CUS result who did not receive anticoagulant therapy, and were followed up at least 90 days for venous thromboembolism events. DATA EXTRACTION: Two authors independently reviewed and extracted data regarding a single positive or negative whole-Leg CUS result, occurrence of venous thromboembolism during follow-up, and study quality. RESULTS: Seven studies were included totaling 4731 patients with negative whole-Leg CUS examinations who did not receive anticoagulation. Of these, up to 647 patients (13.7%) had active cancer and up to 725 patients (15.3%) recently underwent a major surgery. Most participants were identified from an ambulatory setting. Venous thromboembolism or suspected venous thromboembolism-related death occurred in 34 patients (0.7%), including 11 patients with distal DVT (32.4%); 7 patients with proximal DVT (20.6%); 7 patients with nonfatal pulmonary emboli (20.6%); and 9 patients (26.5%) who died, possibly related to venous thromboembolism. Using a random-effects model with inverse variance weighting, the combined venous thromboembolism event rate at 3 months was 0.57% (95% confidence interval, 0.25%-0.89%). CONCLUSION: Withholding anticoagulation following a single negative whole-Leg CUS result was associated with a low risk of venous thromboembolism during 3-month follow-up.

  • safety of excluding suspected deep vein thrombosis with a single whole Leg Compression ultrasound systematic review and meta analysis
    Blood, 2009
    Co-Authors: Stacy A Johnson, Scott M Stevens, Scott C Woller, Erica Lake, Marco P Donadini, James D Douketis
    Abstract:

    Abstract 243 Background: In patients with suspected lower extremity deep vein thrombosis (DVT), Compression ultrasonography (CUS) is typically used as the initial test to confirm or exclude DVT. Patients with a negative CUS and either a moderate-to-high probability and/or a positive D-dimer usually require repeat CUS testing after 5–7 days to exclude proximal propagation of distal DVT, reducing diagnostic efficiency. Whole-Leg Compression ultrasound may safely exclude proximal and distal DVT in a single evaluation. Purpose: To assess the safety of withholding anticoagulation in patients presenting with suspected lower extremity DVT following a single negative whole-Leg CUS. Methods: MEDLINE, EMBASE, CINAHL, LILACS, Cochrane, Health Technology Assessments databases were searched from January 1970 to April 2009 without language restrictions. This search was supplemented by reviewing Google, Google Scholar, clinicaltrials.gov, meeting abstracts, conference proceedings, reference lists, and by contacting content experts. Study Selection and Data Extraction: Randomized controlled trials and prospective cohort studies of patients with suspected DVT with a negative whole-Leg CUS, not treated with anticoagulation, and followed at least 90 days for occurrence of venous thromboembolism (VTE). Studies required objective confirmation of VTE events during follow-up. Two authors independently reviewed articles and extracted data. Results: Six studies were included totaling 4,229 patients with negative whole-Leg CUS exams and not receiving anticoagulation. VTE or suspected VTE-related death occurred within the follow-up period in 24 (0.6%) patients. Of these 24 events, 9 (37.5%) were distal DVT, 7 (29.2%) were proximal DVT, 6 (25.0%) were non-fatal pulmonary embolism, and 2 (8.3%) were deaths, possibly related to VTE. Combined VTE event rate at 3 months was 0.46% (95% CI 0.22, 0.70). Limitations: Pretest probability assessment was not available for all analyzed patients. Conclusions: Withholding anticoagulation in patients with suspected DVT based on a single whole-Leg CUS is associated with a low risk of VTE (0.46%) during 3 months of follow-up. This strategy represents a safe and efficient alternative to serial CUS testing in patients with suspected DVT. Disclosures: No relevant conflicts of interest to declare.