Servier – Phlebolymphology

Venous thromboembolism

Factors affecting long-term outcome in patients with iliofemoral DVT treated with catheter directed thrombolysis.
P. Foegh, L. P. Jensen, L. Klitfod, S. Just, R. Broholm, N. Baekgaard

The Danish team investigated factors affecting long-term outcomes in patients with iliofemoral deep venous thrombosis (DVT) treated with catheter-directed thrombolysis. This method is not widely used because of its cost, but also because its effectiveness is questionable. The team achieved very good results on 203 limbs with iliofemoral DVT. Median follow-up was 5 years and the rate of reocclusion was only 13%. The factors in favor of good outcomes were female sex, type of thrombolytic administration (infusion is better than pulse), duration of symptoms less than 14 days, and absence of a previous DVT on the same leg.

The impact of international VTE guidelines on hospital performance.
A. N. Nicolaides

Despite many efforts of medical specialists all over the world, venous thromboembolism (VTE) prophylaxis in hospitals is still far from ideal. A good one-third of high-risk patients do not receive appropriate prophylaxis. There are many reasons for that, such as lack of awareness with the guidelines, lack of agreement between different expert recommendations, fear of bleeding while using anticoagulants, improper estimation of risk, lack of hospital policies and protocols. Many tools are available to improve this situation from pocket guidelines for doctors and printed guidelines for patients to educational campaigns. Appropriate estimation of the risk of VTE is the key point of effective prevention.

Validation of the Caprini risk score for venous thromboembolism (VTE) in high-risk surgical patients.
K. Lobastov, V. Barinov, L. Laberko, V. Boyarintsev

The attempt to distinguish subgroups of extremely high-risk surgical patients in whom standard measures were insufficient was difficult. The authors followed up 140 patients defined as high risk with a Caprini score and received prophylaxis with compression and low-dose unfractionated heparin (LDUH). In patients with Caprini scores of 5 to 8, the deep venous thrombosis (DVT) rate on prophylaxis was 1.9%; with Caprini scores of 9 to 11, the DVT rate was 26.1%; and with Caprini scores of 12 to 15, the DVT rate was 65%. Authors concluded that patients with Caprini scores ≥11 must be identified as extremely high-risk patients.

What is new in the treatment of acute vein thrombosis?

Recommendations on Superficial Vein Thrombosis.
J-L. Gillet

In contrast with deep venous thrombosis (DVT), no high-grade recommendations for superficial venous thrombosis (SVT) exists. SVT is not a benign disease because it is associated with DVT in 23% to 26% of cases, pulmonary embolism in 4%, and a recurrence rate up to 20% within 2 years. Now, anticoagulant therapy is widely used, but the level of evidence for low-molecular-weight heparin in intermediate doses is moderate according to the International Consensus Statement. Only fondaparinux has a high-level of evidence, but it is an expensive treatment. Further research is needed to define subgroups of patients with a higher incidence of venous thromboembolism after SVT where the benefits of anticoagulants would outweigh the costs.

Thrombolysis.
G. O’Sullivan

The author presented his remarkable experience in thrombolysis in phlegmasia cerulea dolens. He outlined that phlegmasia is not comparable to venous gangrene since clinical symptoms and signs are very different. Thrombolysis was performed in 21 patients using a Trellis device. He achieved a high success rate with no lost limbs and no mortality.