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Herve Decousus - One of the best experts on this subject based on the ideXlab platform.
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spontaneous acute Superficial Vein thrombosis of the legs do we really need to treat
Journal of Thrombosis and Haemostasis, 2015Co-Authors: Laurent Bertoletti, Paul Frappé, Herve DecoususAbstract:Summary. Spontaneous acute Superficial Vein thrombosis (SVT) of the leg is now generally recognized as an integral component of venous thromboembolic disease with potentially severe consequences. However, the relatively low grades of some current international recommendations and uncertainty regarding the cost-effectiveness of available therapies may prompt questioning of the real need to treat patients with SVT and explain the persisting heterogeneity of their management in practise. Yet several studies have consistently shown high rates of thromboembolic complications associated with SVT, whether at first presentation or during follow-up. The CALISTO trial established for the first time the clinical benefit of a welldefined anticoagulant regimen for the prevention of serious thromboembolic complications in SVT patients, and we believe that patients such as those included in this trial should receive this regimen as tested. However, several areas of uncertainty remain for categories of SVT patients not evaluated in CALISTO.
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Management of Superficial Vein thrombosis
La Revue du praticien, 2015Co-Authors: Paul Frappé, Nathalie Moulin, Laurent Bertoletti, Herve DecoususAbstract:Recent epidemiological studies have highlighted the potential severity of Superficial Vein thrombosis of the lower limbs (SVT). Diagnosis is based on clinical and Doppler ultrasonography evaluation, and define its therapeutic management. If SVT is associated with objectively confirmed deep Vein thrombosis or pulmonary embolism, curative anticoagulation is indicated. If SVT is isolated and measured over 5 cm long, prophylactic dosage of fondaparinux may be provided for 45 days.
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clinical relevance of symptomatic Superficial Vein thrombosis extension lessons from the calisto study
Blood, 2013Co-Authors: Alain Leizorovicz, ANJA BUCHMULLER, Paolo Prandoni, Isabelle Quéré, François Becker, Herve DecoususAbstract:The clinical relevance of symptomatic extension of spontaneous, acute, symptomatic, lower-limb Superficial-Vein thrombosis (SVT) is debated. We performed a post hoc analysis of a double-blind trial comparing fondaparinux with placebo. The main study outcome was SVT extension by day 77, whether to
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epidemiology diagnosis treatment and management of Superficial Vein thrombosis of the legs
Best Practice & Research Clinical Haematology, 2012Co-Authors: Laurent Bertoletti, Paul Frappé, ANJA BUCHMULLER, Sandrine Accassat, Benjamin Seffert, Herve Decousus, Adel MerahAbstract:Recent data on lower-limb Superficial-Vein thrombosis (SVT) may substantially impact its clinical management. Particularly, the clear confirmation that SVT is closely linked to deep-Vein thrombosis (DVT) or pulmonary embolism (PE) highlights the potential severity of the disease. DVT or PE is diagnosed in 20–30% of SVT patients. Moreover, clinically relevant symptomatic thromboembolic events complicate isolated SVT (without concomitant DVT or PE at diagnosis) in 4–8% of patients. For the first time, an anticoagulant treatment, once-daily 2.5 mg fondaparinux for 45 days, was demonstrated to be effective and safe for preventing these symptomatic thromboembolic events in patients with lower-limb isolated SVT in the randomized, placebo-controlled CALISTO study. More recent data from another randomized trial support these findings. New recommendations on the management of SVT patients, including complete ultrasonography examination of the legs and, in patients with isolated SVT, prescription of once-daily 2.5 mg fondaparinux subcutaneously for 45 days on top of symptomatic treatments, may be proposed, wherever the cost of fondaparinux is acceptable. Superficial-Vein thrombosis (SVT) of the lower limbs has long been regarded as a benign, self-limiting disease, expected to resolve spontaneously and rapidly, and requiring only symptomatic treatments [1,2]. However, the perception of this disease is now changing with the recent publication of data indicating its potential severity [3] and showing for the first time the benefit of a therapeutic strategy based on the administration of an anticoagulant treatment [4]. The overall management of this frequent disease therefore needs to be reconsidered.
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recent findings in the epidemiology diagnosis and treatment of Superficial Vein thrombosis
Thrombosis Research, 2011Co-Authors: Herve Decousus, Nathalie Moulin, Laurent Bertoletti, Paul Frappé, Patrick Mismetti, Emilie Presles, Asma El Jaouhari, Isabelle Quéré, François Becker, Alain LeizoroviczAbstract:Abstract Recent data on lower-limb Superficial-Vein thrombosis (SVT) may substantially impact its clinical management. Thus, the clear confirmation that SVT is closely linked to deep-Vein thrombosis (DVT) or pulmonary embolism (PE) highlights the potential severity of the disease. DVT or PE are diagnosed in 20-30% of SVT patients. Moreover, clinically relevant symptomatic thromboembolic events complicate isolated SVT (without concomitant DVT or PE at diagnosis) in 4-8% of patients. For the first time, an anticoagulant treatment, once-daily 2.5 mg fondaparinux for 45 days, was demonstrated to be effective and safe for preventing these symptomatic thromboembolic events in patients with lower-limb isolated SVT in the randomized placebo-controlled CALISTO study. Based on these recent findings, new recommendations on the management of SVT patients, including complete ultrasonography examination of the legs, and in patients with isolated SVT, prescription of once-daily 2.5 mg fondaparinux subcutaneously for 45 days on top of symptomatic treatments, may be proposed.
Bernard Tardy - One of the best experts on this subject based on the ideXlab platform.
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seasonal variation in the Superficial Vein thrombosis frequency
Thrombosis Research, 2015Co-Authors: Laurent Bertoletti, Paul Frappé, Adel Merah, Emilie Presles, Andrea Buchmullercordier, Deborah Peycelon, Bernard TardyAbstract:ABSTRACT Introduction A seasonal variation of venous thromboembolic disease frequency is subject to discussion, and has been recently suggested for Superficial Vein thrombosis (SVT) in a small retrospective study. Our aim was to search for a seasonal variation of SVT frequency according to the data of larger studies. Materials and methods We analyzed the data of three French prospective multicenter studies with different designs which have included patients with SVT (STENOX, POST, and STEPH studies). Seasonal variation of SVT frequency was evaluated by comparing the observed seasonal frequency of SVT to a theoretical frequency of 25% for each season. Results The analysis included 1395 patients and 4.75 seasonal cycles. The difference to a theoretical frequency of 25% was statistically significant in one study (POST, p = 0.044). The higher risk difference was − 6.1% (95% CI − 11.7–−0.5) in summer in STENOX, + 7.1% (95% CI + 2.7–+11.5) in winter in POST and 4.2% (95% CI − 5.2–+13.7) in spring in STEPH, corresponding to a relative risk of 0.80, 1.40 and 1.20, respectively. Conclusions A seasonal variation was found in only one study which has the weakest methodology to warrant completeness. Variation pattern was different in each study. If this variation exists, it would probably be too low to have clinical consequences.
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Superficial Vein thrombosis risk factors diagnosis and treatment
Current Opinion in Pulmonary Medicine, 2003Co-Authors: Herve Decousus, Sara Quenet, Magali Epinat, Karine Guillot, C Boissier, Bernard TardyAbstract:Superficial Vein thrombosis (SVT) risk factors are close to those of venous thromboembolism (VTE). Diagnosis is made in a clinical setting but ultrasonography is useful to eliminate concomitant deep Vein thrombosis (DVT). For SVT of the lower limbs, which is the main location, varicose Veins represe
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Superficial Vein thrombosis risk factors diagnosis and treatment
Current Opinion in Pulmonary Medicine, 2003Co-Authors: Herve Decousus, Sara Quenet, Magali Epinat, Karine Guillot, C Boissier, Bernard TardyAbstract:Superficial Vein thrombosis (SVT) risk factors are close to those of venous thromboembolism (VTE). Diagnosis is made in a clinical setting but ultrasonography is useful to eliminate concomitant deep Vein thrombosis (DVT). For SVT of the lower limbs, which is the main location, varicose Veins represent the principal cause but underlying conditions (e.g.: autoimmune diseases, malignancy or thrombophilia) must be sought in idiopathic, migrant or recurrent SVT and in the absence of varicose Veins. Concomitant DVT and pulmonary embolism can occur in approximately 15% and 5% respectively. Historical treatments consist of anti-inflammatory agents plus elastic stockings and, in case of varicose Veins, thrombectomy and stripping. Other treatments (anticoagulants, Vein ligation) were assessed to limit the VTE risk. A one-month prophylactic dose of low molecular weight heparin plus elastic stockings could be the appropriate strategy in most cases. Other studies are needed before definitive conclusions can be drawn.
Pong Kanchanasuttiruk - One of the best experts on this subject based on the ideXlab platform.
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total Superficial Vein reflux eradication in the treatment of venous ulcer
World Journal of Surgery, 2015Co-Authors: Burapa Kanchanabat, Waigoon Stapanavatr, Pong KanchanasuttirukAbstract:Total Superficial Vein reflux eradication in the treatment of venous ulcer. Our initial experience with groin–knee Vein stripping resulted in recurrent or unhealed venous ulcers prompting us to remove the entire reflux segment with emphasis on the calf Superficial Vein adjacent to, or underneath the ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active venous ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active venous ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p < 0.0001 and 1.0, 0.7, p = 0.035 for VCSS and VDS, respectively). Recurrent ulceration was found in four legs. The 2- and 6-year recurrence rates were three percent and 22 percent, respectively. Venous ulcer could be satisfactory treated by the total removal of the peri-ulcer reflux.
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Total Superficial Vein Reflux Eradication in the Treatment of Venous Ulcer
World journal of surgery, 2015Co-Authors: Burapa Kanchanabat, Waigoon Stapanavatr, Pong KanchanasuttirukAbstract:Total Superficial Vein reflux eradication in the treatment of venous ulcer. Our initial experience with groin–knee Vein stripping resulted in recurrent or unhealed venous ulcers prompting us to remove the entire reflux segment with emphasis on the calf Superficial Vein adjacent to, or underneath the ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active venous ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active venous ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p
Sara Quenet - One of the best experts on this subject based on the ideXlab platform.
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factors predictive of venous thrombotic complications in patients with isolated Superficial Vein thrombosis
Journal of Vascular Surgery, 2003Co-Authors: Sara Quenet, Silvy Laporte, Alain Leizorovicz, Magali Epinat, Herve Decousus, Patrick MismettiAbstract:OBJECTIVE: Superficial Vein thrombosis may be complicated with venous thromboembolism. We examined factors predictive of venous thromboembolism in Superficial Vein thrombosis, which, to our knowledge, had not been prospectively studied before. DESIGN AND METHODS: We performed post hoc analysis of the STENOX trial, a prospective randomized controlled trial that investigated various antithrombotic therapies in 427 hospitalized patients with objectively confirmed symptomatic isolated Superficial Vein thrombosis. The value of various baseline characteristics as predictive factors of venous thrombotic complications at 3 months was studied with logistic regression. Venous thrombotic complications were defined as deep Vein thrombosis or pulmonary embolism, or recurrence or proximal extension of Superficial Vein thrombosis. RESULTS: Venous thrombotic complications occurred in 78 patients. Independent predictive factors for complications were Superficial Vein thrombosis of recent onset (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.44-6.27), severe chronic venous insufficiency (OR, 2.75; CI, 1.10-6.89), male gender (OR, 2.17; CI, 1.28-3.68), and history of venous thromboembolism (OR, 2.07; CI 1.06-4.04). Deep Vein thrombosis or pulmonary embolism occurred in 19 patients. Only severe chronic venous insufficiency was an independent predictor of this complication (OR, 4.50; CI, 1.30-15.61). CONCLUSIONS: After symptomatic isolated Superficial Vein thrombosis, venous thrombotic complications are relatively frequent, and are more likely to occur in men, in patients with a history of venous thromboembolism or with severe chronic venous insufficiency, or in whom Superficial Vein thrombosis is recent. Knowledge of such predictive factors may be useful for determining appropriate treatment in patients with Superficial Vein thrombosis and for designing future phase III clinical trials.
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Superficial Vein thrombosis risk factors diagnosis and treatment
Current Opinion in Pulmonary Medicine, 2003Co-Authors: Herve Decousus, Sara Quenet, Magali Epinat, Karine Guillot, C Boissier, Bernard TardyAbstract:Superficial Vein thrombosis (SVT) risk factors are close to those of venous thromboembolism (VTE). Diagnosis is made in a clinical setting but ultrasonography is useful to eliminate concomitant deep Vein thrombosis (DVT). For SVT of the lower limbs, which is the main location, varicose Veins represe
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Superficial Vein thrombosis risk factors diagnosis and treatment
Current Opinion in Pulmonary Medicine, 2003Co-Authors: Herve Decousus, Sara Quenet, Magali Epinat, Karine Guillot, C Boissier, Bernard TardyAbstract:Superficial Vein thrombosis (SVT) risk factors are close to those of venous thromboembolism (VTE). Diagnosis is made in a clinical setting but ultrasonography is useful to eliminate concomitant deep Vein thrombosis (DVT). For SVT of the lower limbs, which is the main location, varicose Veins represent the principal cause but underlying conditions (e.g.: autoimmune diseases, malignancy or thrombophilia) must be sought in idiopathic, migrant or recurrent SVT and in the absence of varicose Veins. Concomitant DVT and pulmonary embolism can occur in approximately 15% and 5% respectively. Historical treatments consist of anti-inflammatory agents plus elastic stockings and, in case of varicose Veins, thrombectomy and stripping. Other treatments (anticoagulants, Vein ligation) were assessed to limit the VTE risk. A one-month prophylactic dose of low molecular weight heparin plus elastic stockings could be the appropriate strategy in most cases. Other studies are needed before definitive conclusions can be drawn.
Magali Epinat - One of the best experts on this subject based on the ideXlab platform.
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factors predictive of venous thrombotic complications in patients with isolated Superficial Vein thrombosis
Journal of Vascular Surgery, 2003Co-Authors: Sara Quenet, Silvy Laporte, Alain Leizorovicz, Magali Epinat, Herve Decousus, Patrick MismettiAbstract:OBJECTIVE: Superficial Vein thrombosis may be complicated with venous thromboembolism. We examined factors predictive of venous thromboembolism in Superficial Vein thrombosis, which, to our knowledge, had not been prospectively studied before. DESIGN AND METHODS: We performed post hoc analysis of the STENOX trial, a prospective randomized controlled trial that investigated various antithrombotic therapies in 427 hospitalized patients with objectively confirmed symptomatic isolated Superficial Vein thrombosis. The value of various baseline characteristics as predictive factors of venous thrombotic complications at 3 months was studied with logistic regression. Venous thrombotic complications were defined as deep Vein thrombosis or pulmonary embolism, or recurrence or proximal extension of Superficial Vein thrombosis. RESULTS: Venous thrombotic complications occurred in 78 patients. Independent predictive factors for complications were Superficial Vein thrombosis of recent onset (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.44-6.27), severe chronic venous insufficiency (OR, 2.75; CI, 1.10-6.89), male gender (OR, 2.17; CI, 1.28-3.68), and history of venous thromboembolism (OR, 2.07; CI 1.06-4.04). Deep Vein thrombosis or pulmonary embolism occurred in 19 patients. Only severe chronic venous insufficiency was an independent predictor of this complication (OR, 4.50; CI, 1.30-15.61). CONCLUSIONS: After symptomatic isolated Superficial Vein thrombosis, venous thrombotic complications are relatively frequent, and are more likely to occur in men, in patients with a history of venous thromboembolism or with severe chronic venous insufficiency, or in whom Superficial Vein thrombosis is recent. Knowledge of such predictive factors may be useful for determining appropriate treatment in patients with Superficial Vein thrombosis and for designing future phase III clinical trials.
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Superficial Vein thrombosis risk factors diagnosis and treatment
Current Opinion in Pulmonary Medicine, 2003Co-Authors: Herve Decousus, Sara Quenet, Magali Epinat, Karine Guillot, C Boissier, Bernard TardyAbstract:Superficial Vein thrombosis (SVT) risk factors are close to those of venous thromboembolism (VTE). Diagnosis is made in a clinical setting but ultrasonography is useful to eliminate concomitant deep Vein thrombosis (DVT). For SVT of the lower limbs, which is the main location, varicose Veins represe
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Superficial Vein thrombosis risk factors diagnosis and treatment
Current Opinion in Pulmonary Medicine, 2003Co-Authors: Herve Decousus, Sara Quenet, Magali Epinat, Karine Guillot, C Boissier, Bernard TardyAbstract:Superficial Vein thrombosis (SVT) risk factors are close to those of venous thromboembolism (VTE). Diagnosis is made in a clinical setting but ultrasonography is useful to eliminate concomitant deep Vein thrombosis (DVT). For SVT of the lower limbs, which is the main location, varicose Veins represent the principal cause but underlying conditions (e.g.: autoimmune diseases, malignancy or thrombophilia) must be sought in idiopathic, migrant or recurrent SVT and in the absence of varicose Veins. Concomitant DVT and pulmonary embolism can occur in approximately 15% and 5% respectively. Historical treatments consist of anti-inflammatory agents plus elastic stockings and, in case of varicose Veins, thrombectomy and stripping. Other treatments (anticoagulants, Vein ligation) were assessed to limit the VTE risk. A one-month prophylactic dose of low molecular weight heparin plus elastic stockings could be the appropriate strategy in most cases. Other studies are needed before definitive conclusions can be drawn.