Utility of Venoactive Compounds in Postthrombotic Syndrome – Systematic Review

The postthrombotic syndrome (PTS) is defined as secondary chronic venous insufficiency (CVI) resulting from deep vein thrombosis (DVT), with Villalta score of  > 5 for clinically meaningful PTS. In the Registro Informatizado Enfermedad Tromboembólica  (RIETE), registry of 33897 patients, one year after DVT, symptoms and/or signs of PTS were reported in 47.6% of individuals with isolated DVT and in 60.5% of those with proximal DVT. Prevention and treatment of PTS remain challenging. As venoactive compounds demonstrated their efficacy in the CVI, this systematic review aims to determine if there is valid scientific evidence on their utility in the PTS.

 

Methods:

A preliminary literature search on PubMed, that included Medline, life science journals and Cochrane library, from 1/1/1980 to 7/14/2023 was performed. All relevant references quoted in the other reviews or coming from the authors’ libraries will also be considered. The selection criteria are randomized controlled trials (RCT) or systematic review/meta-analyses of RCTs, published in English, including patients with PTS or at risk of the PTS and any treatment with VAC. The systematic review conducted by 5 reviewers will follow the PRISMA Guidelines as well as the revised Cochrane risk-of-bias tool for RCTs. The evaluation of the quality of evidence will precede the report on the assessment of the PTS diagnosis, the VAC treatment safety and efficacy on PTS symptoms, Quality of Life (QoL), and signs that include edema, trophic skin changes, and ulcers. The studies in the prevention and treatment of PTS with VAC will be analyzed in a separate group of RCTs. 

 

Results:

Preliminary results yielded 2134 papers on PTS. We identified 11 systematic reviews and meta-analyses and 36 RCTs, that have to be further examined to confirm the inclusion of patients with PTS or at risk of PTS and VAC treatment.

Conclusions:

The systematic review on VAC in the treatment and prevention of PTS will provide clinical evidence on the effectiveness for safe and beneficial therapy in this debilitating chronic venous disorder, which often progresses to more severe stages of CVI that significantly affect QoL and are difficult to prevent and manage.