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Long-term sequelae of calf vein thrombosis treated with heparin or low-dose streptokinase
Insights
Long-term calf vein thrombosis (CVT) sequelae were similar between heparin and streptokinase (SK) treatments. Limiting CVT extent may reduce venous insufficiency, but SK is not recommended due to side effects.
Area of Science:
- Vascular Medicine
- Thrombosis Research
- Clinical Trials
Background:
- Calf vein thrombosis (CVT) can lead to long-term venous insufficiency.
- Understanding the impact of initial treatment on long-term outcomes is crucial.
Purpose of the Study:
- To investigate long-term sequelae of CVT.
- To correlate these sequelae with the success of initial treatment (heparin vs. low-dose streptokinase).
Main Methods:
- Prospective randomized study of 36 patients with symptomatic CVT.
- Treatment with heparin or low-dose streptokinase (SK) plus heparin.
- Venography at baseline and 1 week.
- Clinical follow-up and foot volumetry at an average of 5 years.
Main Results:
- No significant difference in thrombus size after treatment between groups.
- Long-term sequelae and foot volumetry results were similar.
- 37% showed signs of venous insufficiency; 26% had deep venous insufficiency.
- Correlation found between hemodynamic changes (foot volumetry) and venographic severity, stronger for post-treatment thrombus size.
Conclusions:
- Limiting the extent of CVT appears important for minimizing long-term sequelae.
- Low-dose SK is not justified due to serious hemorrhagic side effects observed in a parallel study.
- Heparin and low-dose SK showed similar long-term outcomes for CVT.
Abstract:
A prospective randomized study was performed to investigate the long-term sequelae of calf vein thrombosis (CVT) and correlate them to the success of the initial treatment. Thirty-six patients with symptomatic CVT, verified by venography, were treated with heparin or low-dose streptokinase (SK) combined with low-dose heparin. Venography was repeated after 1 week, and long-term follow-up was performed clinically and with foot volumetry after an average of 5 years. Since the low-dose SK regimen led to serious hemorrhagic side-effects in a parallel study, the present investigation was discontinued prematurely. The thrombolysis achieved was greater with SK but, since the initial thrombi were somewhat larger in this group, no significant difference in the average size of the thrombi after therapy could be displayed between the groups. The long-term sequelae and results of foot volumetry were also equal. Signs or symptoms of venous insufficiency were found in 37%, and foot volumetry showed deep venous insufficiency in 26% of the cases. There was a correlation between the hemodynamic change, as assessed by foot volumetry, and the venographic severity. This relation was stronger for the size of the thrombus after treatment than for the initial size. Thus, it seems important to limit the extent of a CVT in order to minimize the long-term sequelae, but administration of SK is not justified due to side-effects.