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A Journal on Phlebology
Acta Phlebologica 2012 August;13(2):105-8
News on distal deep venous thrombosis. Preliminary reports of a multicentre study
Guarnera G. 1, Abeni D. 1, Antignani P. L. 2, Apollonio A. 3, Conti F. 4, Mollo P. L. 5, Murgiano A. 6, Ofria F. 7, Ruggieri M. 8
1 IDI-IRCCS, Rome, Italy;
2 San Giovanni Hospital, Rome, Italy;
3 Viterbo Belcolle Hospital, Viterbo, Italy;
4 San Camillo Hospital, Rome, Italy;
5 Anagni Hospital, Frosinone, Italy;
6 Israelitico Hospital, Rome, Italy;
7 Anzio Hospital, Anzio, Rome, Italy;
8 Rieti Hospital, Rieti, Italy
Aim. No study of strong methodology could be found to solve the controversy of optimal treatment of distal deep venous thrombosis (DDVT). Some inconclusive pieces of evidence exist on two approaches: anticolagulants and compression therapy versus compression therapy and Duplex scanning monitoring. Different studies report propagation to popliteal vein in 8% of patients without anticoagulant treatment, while a complete thrombus resolution within four weeks occurred in 20% of patients. We report preliminary data of a study conducted in patients affected by DDVT and treated with nadroparin in mono-administration associated with compression therapy.
Methods. One hundred and eleven patients with DDVT of the gastrocnemius or tibial veins, assessed by Duplex scanning, were enrolled in eight clinical centers in Lazio, Italy. At baseline, socio-demographic information, medical history (including risk factors for DDVT), circumferences of both calves and ankles, and a VAS-pain scale were recorded. At 7 and 28 days from baseline patients were re-assessed by Duplex scanning, calves and ankles circumferences and VAS-pain were measured, and the patients were asked about possible side effects.
Results. At the end of the study period, no propagation to the popliteal vein was observed, and no side effects were reported. The calf circumference in the affected leg overall significantly decreased from baseline (38.1 cm) to week 1 (37.1cm), and to week 4 (35.7 cm). Also the VAS-pain scores significantly decreased during the study: the observed means were 58.4, 30.7, and 12.7 at the three visits. Data on thrombus resolution are under evaluation.
Conclusion. Our study suggests that anticoagulant treatment, associated with compression therapy, is safe and causes clinical improvement (as assessed by the calf measurements) and pain relief. An increase of the probability of a complete thrombus resolution is expected. Such preliminary results, together with the already reported higher satisfaction of patients for the mono-administration of this therapy, should be considered as a viable option for the treatment of DDVT.