静脉活性化合物在血栓形成后综合征中的应用：系统综述。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders Pub Date : 2025-03-16 DOI:10.1016/j.jvsv.2025.102228

Monika L. Gloviczki MD, PhD, DFAVF , Julianne Stoughton MD, FACS, DFAVF, ABVLM , Alessandra Puggioni MD, DFAVF, RPVI, RPhS , Peter Gloviczki MD, PhD, FACS, DFSVS, DFAVF , Joseph D. Raffetto MD, FACS, DFAVF

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引用次数: 0

摘要

背景：血栓形成后综合征（PTS）非常普遍，超过50%的患者在下肢急性深静脉血栓形成（DVT）后发生PTS。静脉活性化合物（VACs）几十年来一直被推荐用于慢性静脉功能不全（CVI）患者，包括PTS。本研究的目的是进行一项系统综述，以确定VACs在预防和治疗PTS方面的有效性的证据质量。方法：采用PubMed、Medline、生命科学期刊和Cochrane图书馆检索1980年1月1日至2023年7月14日期间静脉活性药物或药物、DVT和PTS的文献进行系统回顾。本综述仅纳入以英文发表的随机对照试验（RCTs）。采用PRISMA指南和修订后的Cochrane随机对照试验风险偏倚工具。结果：共纳入文献94篇，11篇rct符合纳入标准。给药的VAC是地奥米明、汗臭米/芦果苷、微粉纯化类黄酮提取物（MPFF）和苏洛地脂。这些研究包括了高度可变的PTS患者比例（8.6%至100%）。一些较早的研究忽略了方法论的细节。两项研究表明，地奥米明和MPFF作为利伐沙班的辅助治疗在预防PTS方面有好处，并且显示低或不明确的偏倚风险。对治疗血栓性CVI的随机对照试验的评估发现，81.6%至85.7%的患者存在低或不明确的偏倚风险。所有的研究都表明VACs对PTS治疗是有益的，它们改善了静脉症状，减少了水肿，并帮助静脉溃疡愈合。结论：本系统综述发现，VACs在改善静脉症状、减少水肿和加速静脉溃疡愈合方面至少具有中等质量的证据。两项高质量的试点随机对照试验表明，地奥司明和MPFF作为利伐沙班治疗的辅助治疗，可以减少PTS的发生率，改善深静脉再通。由于大多数随机对照试验发表于20多年前，其中一些报告缺乏所需的准确性，因此需要新的高质量，低偏倚的随机对照试验来评估特定VACs在预防和治疗PTS方面的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Utility of venoactive compounds in post-thrombotic syndrome: A systematic review

查看原文本刊更多论文

Utility of venoactive compounds in post-thrombotic syndrome: A systematic review

Background

Post-thrombotic syndrome (PTS) has been highly prevalent; over 50% of the patients develop PTS after lower extremity acute deep vein thrombosis. Venoactive compounds (VACs) have been recommended for decades for patients with chronic venous insufficiency, including PTS. The objective of our study was to perform a systematic review to determine the quality of evidence on the utility of VACs for both prevention and treatment of PTS.

Methods

A systematic review was conducted to search the literature between January 1, 1980, and July 14, 2023, for venoactive drugs or medications, deep vein thrombosis, and PTS using PubMed, MEDLINE, life science journals, and the Cochrane Library. Only randomized controlled trials (RCTs) published in English were included in this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the revised Cochrane risk-of-bias tool for RCTs were used.

Results

Ninety-four references were identified; 11 RCTs fulfilled the inclusion criteria. VACs administered were diosmin, hidrosmin/rutosides, micronized purified flavonoid fraction (MPFF), and sulodexide. The studies included a highly variable proportion of patients with PTS (8.6%-100%). Some older studies omitted details of the methodology. Two studies suggested benefit of diosmin and MPFF as adjunctive treatment to rivaroxaban in the prevention of PTS and showed low or unclear risk of bias. Evaluation of RCTs for the treatment of post-thrombotic chronic venous insufficiency found low or unclear risk of bias in 81.6% to 85.7%. All studies suggested that VACs were beneficial for PTS treatment; they improved venous symptoms, decreased edema, and helped heal venous ulcers.

Conclusions

This systematic review found that VACs had at least moderate quality of evidence in improving venous symptoms, decreasing edema, and accelerating venous ulcer healing. Two pilot RCTs of higher quality suggested the usefulness of diosmin and MPFF as adjunctive treatment to rivaroxaban therapy to reduce the incidence of PTS and improve deep vein recanalization. Because most RCTs were published over two decades ago, and several lacked the required precision in reporting, new high-quality, low-bias RCTs are needed to assess the role of specific VACs for both prevention and treatment of PTS.

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来源期刊

Journal of vascular surgery. Venous and lymphatic disorders SURGERYPERIPHERAL VASCULAR DISEASE&n-PERIPHERAL VASCULAR DISEASE

CiteScore

6.30

自引率

18.80%

发文量

328

审稿时长

71 days

期刊介绍： Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.