Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.006817
Jornal Vascular Brasileiro
Review Article

Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome

Uso da terapia compressiva ou não compressiva na trombose venosa profunda e síndrome pós-trombótica: dois caminhos divergentes

Eduardo Simões Da Matta

Downloads: 0
Views: 403

Abstract

Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the “valve mechanism” generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

Keywords

deep vein thrombosis; post-thrombotic syndrome; compression therapy; adjustable velcro compression device.

Resumo

O uso da terapia de compressão para reduzir a incidência de síndrome pós-trombótica em pacientes com trombose venosa profunda apresenta controvérsias como o uso da compressão elástica versus inelástica, os níveis e a duração da compressão. Dispositivos inelásticos com índice de rigidez estática combinam uma pressão pequena e confortável em repouso com uma pressão forte o suficiente para restaurar o “mecanismo de válvula” gerado pela flexão plantar e dorsiflexão do pé. Uma vez que o índice de rigidez estática depende da rigidez do sistema de compressão e da força muscular dentro da área enfaixada, a melhoria da massa muscular com programas de fortalecimento e treinamento de resistência deve ser incentivada. Na fase aguda dos eventos de trombose venosa profunda, a anticoagulação acompanhada de terapia de compressão inelástica pode reduzir a extensão do trombo. Assim, são necessários estudos que avaliem a eficácia da terapia inelástica na trombose venosa profunda e na síndrome pós-trombótica.

Palavras-chave

trombose venosa profunda; síndrome pós-trombótica; terapia de compressão; dispositivo de compressão de velcro ajustável.

References

1. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for vte disease. Chest. 2016;149(2):315-52. PMid:26867832. http://dx.doi.org/10.1016/j.chest.2015.11.026.

2. Kahn SR, Shapiro S, Wells PS, et al. Compression stockings to prevent post-thrombotic syndrome: A randomised placebocontrolled trial. Lancet. 2014;383(9920):880-8. PMid:24315521. http://dx.doi.org/10.1016/S0140-6736(13)61902-9.

3. Partsch H. Compression–from thrombosis to postthrombotic syndrome. Phlebologie. 2014;43(5):227-31. http://dx.doi.org/10.12687/phleb2215-5-2014.

4. Partsch H, Blättler W. Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. J Vasc Surg. 2000;32(5):861-9. PMid:11054217. http://dx.doi.org/10.1067/mva.2000.110352.

5. Van Dongen CJ, Prandoni P, Frulla M, Marchiori A, Prins MH, Hutten BA. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. JTH. 2005;3(5):939-42. PMid:15869588.

6. Chitsike R, Rodger M, Kovacs M, et al. Risk of post-thrombotic syndrome after subtherapeutic warfarin anticoagulation for a first unprovoked deep vein thrombosis: results from the reverse study. JTH. 2012;10(10):2039-44. PMid:22846068.

7. Baglin T. Prevention of post-thrombotic syndrome: a case for new oral anticoagulant drugs or for heparins? JTH. 2012;10(8):1702-3. PMid:22672412.

8. Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies. Circulation. 2014;130(18):1636-61. PMid:25246013. http://dx.doi.org/10.1161/CIR.0000000000000130.

9. Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: The vein-term transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49(2):498-501. PMid:19216970. http://dx.doi.org/10.1016/j.jvs.2008.09.014.

10. Lim KH, Hill G, Tarr G, van Rij A. Deep venous reflux definitions and associated clinical and physiological significance. J Vasc Surg Venous Lymphat Disord. 2013;1(4):325-32. PMid:26992752. http://dx.doi.org/10.1016/j.jvsv.2012.12.003.

11. Bry JD, Muto PA, O’Donnell TF, Isaacson LA. The clinical and hemodynamic results after axillary-to-popliteal vein valve transplantation. J Vasc Surg. 1995;21(1):110-9. PMid:7823349. http://dx.doi.org/10.1016/S0741-5214(95)70249-0.

12. Eriksson I, Almgren B. Influence of the profunda femoris vein on venous hemodynamics of the limb: experience from thirty-one deep vein valve reconstructions. J Vasc Surg. 1986;4(4):390-5. PMid:3761484. http://dx.doi.org/10.1016/0741-5214(86)90236-3.

13. Hall JE. Guyton and hall textbook of medical physiology. Philadelphia: Elsevier Health Sciences; 2015.

14. Partsch HE, Rabe E, Stemmer R. Compression therapy of the extremities. Paris: Editions Phlebologiques Francaises; 2000.

15. Thomaz JB, Belczak CEQ. Tratado de Flebologia e Linfologia. Rio de Janeiro: Rubio; 2006.

16. Brizzio EO. Bombas impulso-aspirativas de los miembros inferiores. Angiologia. 1988;40(6):197-202. PMid:3232857.

17. Denison HJ, Cooper C, Sayer AA, Robinson SM. Prevention and optimal management of sarcopenia: A review of combined exercise and nutrition interventions to improve muscle outcomes in older people. Clin Interv Aging. 2015;10:859-69. PMid:25999704.

18. Partsch H. Compression for the management of venous leg ulcers: which material do we have? Phlebology. 2014;29(1, Suppl):140-5. PMid:24843100. http://dx.doi.org/10.1177/0268355514528129.

19. Balance TF. Edema in venous insufficiency. Phlebolymphology. 2011;18(1):3-14.

20. Roumen-Klappe E, Den Heijer M, Van Rossum J, et al. Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome. J Thromb Thrombolysis. 2009;27(4):400-5. PMid:18480967. http://dx.doi.org/10.1007/s11239-008-0229-7.

21. Mosti G, Cavezzi A, Partsch H, Urso S, Campana F. Adjustable velcro compression devices are more effective than inelastic bandages in reducing venous edema in the initial treatment phase: a randomized controlled trial. Eur J Vasc Endovasc Surg. 2015;50(3):368-74. PMid:26160211. http://dx.doi.org/10.1016/j.ejvs.2015.05.014.

22. Schuren J, Bichel J. Sub-bandage dynamics: stiffness unravelled. Veins and Lymphatics. 2013;2(1):2. http://dx.doi.org/10.4081/vl.2013.e2.

23. Thompson WR, Gordon NF, Pescatello LS. ACSM’s guidelines for exercise testing and prescription. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2010.

24. Partsch H, Lee B. Phlebology and lymphology: a family affair. London: SAGE Publications; 2014.

5cd2e5fd0e88250b0c632f8e jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections