ORIGINAL ARTICLE   

Minerva Cardioangiologica 2018 June;66(3):238-45

DOI: 10.23736/S0026-4725.18.04618-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Prevention of recurrent venous thrombosis and post-thrombotic syndrome

Gianni BELCARO ✉, Mark DUGALL, Shu HU, Beatrice FERAGALLI, Roberto COTELLESE, Andrea LEDDA, Marcello CORSI, Andrea RICCI, Edmondo IPPOLITO, Bruno M. ERRICHI, Umberto CORNELLI, M. Rosaria CESARONE, Morio HOSOI

Irvine3 Labs, Circulation Sciences and The Nicolaides’ Lab, Dipartimento Sc Med OR BIOTEC, CH-PE University, IA-PSS, Pescara, Italy

BACKGROUND: This retrospective registry study evaluated different managements on the development of post-thrombotic syndrome (PTS) and recurrent deep venous thrombosis (R-DVT). The effects of aspirin (100 mg/day), added to the “standard management” (SM) (IUA consensus), were observed in patients after a proximal DVT.
METHODS: The study started after the anticoagulant period. Comparable groups used the mild-antithrombotic agent Pycnogenol® (200 mg/day), ticlopidine (250 mg/day) or sulodexide (500 ULS/day).
RESULTS: The groups were comparable for sex and age distribution and clinical pictures. In the SM group, 222 patients completed the follow-up (72 months). With SM, the percentage of patients with R-DVT (requiring anticoagulants) was 17.2%; 19.8% of SM patients had a PTS. In the aspirin group (202 subjects), R-DVT was observed in 14.8% of patients; 17.32% had a PTS. The reduction in R-DVT and PTS with aspirin was significant (P<0.05) vs. the SM. There was no tolerability problem in subjects using Pycnogenol® (137 patients); they had a much lower incidence of R-DVT (5.8%) and PTS (6.5%) vs. SM and aspirin (P<0.05). Ticlopidine (121 patients) reduced the incidence of R-DVT (12.4%) and PTS (19.8% of patients) (P<0.05 vs. SM). With sulodexide the incidence of R-DVT was 6.7% (P<0.05 vs. SM); the incidence of PTS was 16.6% (P<0.05 vs. SM). The combined R-DVT+PT syndrome was observed in 14.9% of subjects using SM and in 12.9% of subjects using aspirin (P<0.05 vs. SM), in 3.6% of subjects managed with Pycnogenol® (<0.05% vs. aspirin and all other managements). The incidence was 10.74% with ticlopidine and 6.7% with sulodexide (both significantly lower than SM).
CONCLUSIONS: Interaction between PTS and R-DVT are complex; recurrences cause more PTSs, and a post-thrombotic limb is prone to R-DVT. Aspirin, for patients that can tolerate it, reduces the occurrence of PTS and R-DVT. In addition, ticlopidine and sulodexide are effective. Pycnogenol® is the most effective and safe for R-DVT and particularly PTS. Its full range of anti-thrombotic activity is now under evaluation.

KEY WORDS: Venous thrombosis - Post-thrombotic syndrome - Anticoagulants - Aspirin - Ticlopidine - Pycnogenols