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Annals of Surgery Aug 2023The primary objective of this systematic review and meta-analysis was to elucidate the rate of venous thromboembolism (VTE) after endovenous interventions for varicose... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The primary objective of this systematic review and meta-analysis was to elucidate the rate of venous thromboembolism (VTE) after endovenous interventions for varicose veins in the presence of pharmacological and mechanical thromboprophylaxis versus mechanical thromboprophylaxis alone.
BACKGROUND
The VTE rate after endovenous procedures for varicose veins is higher than other day-case procedures and could be reduced with pharmacological thromboprophylaxis.
METHODS
The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines with a registered protocol (PROSPERO: CRD42021274963). Studies of endovenous intervention for superficial venous incompetence reporting the predefined outcomes with at least 30 patients were eligible. Data were pooled with a fixed effects model.
RESULTS
There were 221 trials included in the review (47 randomized trial arms, 105 prospective cohort studies, and 69 retrospective studies). In randomized trial arms, the rate of deep venous thrombosis with additional pharmacological thromboprophylaxis was 0.52% (95% CI, 0.23%-1.19%) (9 studies, 1095 patients, 2 events) versus 2.26% (95% CI, 1.81%-2.82%) (38 studies, 6951 patients, 69 events) with mechanical thromboprophylaxis alone. The rate of pulmonary embolism in randomized trial arms with additional pharmacological thromboprophylaxis was 0.45% (95% CI, 0.09-2.35) (5 studies, 460 participants, 1 event) versus 0.23% (95% CI, 0.1%-0.52%) (28 studies, 4834 participants, 3 events) for mechanical measures alone. The rate of EHIT grade III to IV was 0.35% (95% CI, 0.09-1.40) versus 0.88% (95% CI, 0.28%-2.70%). There was 1 VTE-related mortality and 1 instance of major bleeding, with low rates of minor bleeding.
CONCLUSIONS
There is a significant reduction in the rate of DVT with additional pharmacological thromboprophylaxis and routine prescription of anticoagulation after endovenous varicose vein intervention should be considered. VTE risk for individual study participants is heterogeneous and risk stratification in future randomized interventional studies is critical to establish the clinical effectiveness and safety of additional pharmacological thromboprophylaxis.
Topics: Humans; Anticoagulants; Venous Thromboembolism; Varicose Veins
PubMed: 36205129
DOI: 10.1097/SLA.0000000000005709 -
Vascular Oct 2023Few studies have reported on the safety and durability of adipose-derived stem cells (ADSCs) to support healing in patients with venous leg ulcers (VLU). To establish if... (Review)
Review
OBJECTIVES
Few studies have reported on the safety and durability of adipose-derived stem cells (ADSCs) to support healing in patients with venous leg ulcers (VLU). To establish if there is any evidence to support ADSC use in VLU patients, a systematic review was conducted.
METHODS
A systematic review was conducted following the PRISMA guidelines. PubMed and Embase databases were searched for relevant papers. References from retrieved papers were reviewed to identify any extra eligible studies.
RESULTS
After duplicate removal, 950 papers were screened for eligibility of which 932 were excluded based on title and abstract. Four papers were included in the final analysis (one randomised study and three non-randomised studies). 66 patients in total received ADSCs for VLU treatment. The only randomised paper reported 6-month healing rates of 75% with ADSCs compared to 50% in controls. 100% healing was achieved in one study. The remaining 2 studies reported 25% and 58% healing; however, they included patients with relatively large VLUs. Pain scores decreased after ADSCs application where reported. No serious procedure related complications were reported.
CONCLUSION
ADSCs may enhance ulcer healing in patients with chronic VLU and appears safe based on initial reports. Large, randomised trials are needed to definitively establish the technique's role in VLU patients.
Topics: Humans; Varicose Ulcer; Ulcer; Wound Healing; Stem Cells
PubMed: 35491989
DOI: 10.1177/17085381221098279 -
The International Journal of Lower... Jun 2024The venous leg ulcers are debilitating, painful, and often unresponsive to advanced dressing treatments, so drugs used locally and systematically are essential adjuvant... (Meta-Analysis)
Meta-Analysis
The venous leg ulcers are debilitating, painful, and often unresponsive to advanced dressing treatments, so drugs used locally and systematically are essential adjuvant therapy-pentoxifylline (PTX) whose anti-inflammatory effects may offer a promising avenue to treat venous leg ulcers. However, the current results are controversial. To further evaluate the efficacy and safety of PTX, we performed an updated meta-analysis of randomized placebo-controlled trials of PTX in the treatment of venous leg ulcers. We systematically searched multiple electronic databases PubMed, Web of Science, Embase, the Cochrane Library, the Cochrane Central Register of Controlled Trials, China Science and Technology Journal Database, WanFang Data, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Database to identify eligible studies. Randomized clinical trials of pentoxifylline versus placebo treatment in patients with venous leg ulcers were considered for inclusion. The primary outcomes included ulcer healing rate and the incidence of adverse events after treatment. The secondary outcomes were the ulcer significant improvement (the ulcer size shrank by more than 60% after treatment) rate, mean duration of complete wound healing and changes in mean ulcer size. A meta-analysis and qualitative analysis were conducted to estimate endpoints. A total of 13 randomized clinical trials, including 921 individuals, were finally included. Compared with placebo, pentoxifylline significantly improved the ulcer healing rate (RR = 1.59, 95%CI 1.22 to 2.07, < .001) and significant improvement rate (RR = 2.36, 95%CI 1.31 to 4.24, = .004) while increased the incidence of gastrointestinal disturbances (RR = 2.29, 95%CI 1.04 to 5.03, = .04) at the same time. Moreover, pentoxifylline also shortened mean duration of complete wound healing ( = .007) and shrank ulcer size ( = .02). Currently available evidence suggests that pentoxifylline could help venous leg ulcers heal more quickly and effectively. However, the evidence is insufficient to prove the results due to moderate-certainty evidence. Large-scale, well-designed randomized clinical trials are warranted.
Topics: Humans; Pentoxifylline; Randomized Controlled Trials as Topic; Treatment Outcome; Varicose Ulcer; Wound Healing
PubMed: 34779680
DOI: 10.1177/15347346211050769 -
The International Journal of Lower... Dec 2023To systematically evaluate the clinical effects of platelet-rich plasma in the treatment of lower limb venous ulcers by applying a meta-analysis method. The Pubmed,... (Meta-Analysis)
Meta-Analysis Review
To systematically evaluate the clinical effects of platelet-rich plasma in the treatment of lower limb venous ulcers by applying a meta-analysis method. The Pubmed, Cochrance Library, Embase, and OVID EBM Reviews databases were searched for the search terms'platelet-rich plasma" or "Plasma, Platelet-Rich" or "Platelet Rich Plasma" and "lower extremity venous ulcers' or "Leg Ulcers' or "Ulcer, Leg", and a meta-analysis was performed on the published research literature on platelet-rich plasma for lower extremity venous ulcers from January 1900 to April 2021. The outcome indicators were: post-treatment trauma area and healing rate. Revman 5.3 statistical software was applied for meta-analysis. A total of 294 patients with lower extremity venous ulcers were included in six publications, including 148 patients in the experimental group treated with PRP versus 146 patients in the control group treated with conventional therapy. There was a statistically significant difference in the Formula of an ellipse at the end of treatment (CM²) between the experimental group and the control group, with a mean difference of -1.19 (95% CI -1.80 to -0.58, = .0001; 6 studies, 294 participants moderate quality of evidence). The difference between the healing rate of the experimental group and the control group was statistically significant, with a risk ratio (RR) of 5.73 (95% CI 3.29 - 9.99, < .00001; 5 studies, 248 participants moderate quality of evidence).There may be publication bias for both Formula of an ellipse at the end of treatment and healing rate. This comprehensive meta-analysis of available evidence suggests that the application of PRP for lower extremity venous ulcers accelerates the wound healing process and improves wound healing rates.
Topics: Humans; Varicose Ulcer; Wound Healing; Leg Ulcer; Platelet-Rich Plasma; Lower Extremity
PubMed: 34665051
DOI: 10.1177/15347346211046203