Effect of anticoagulant treatment on pain in distal deep vein thrombosis: an ancillary analysis from the cactus trial
Author(s): ,
Marc Righini
Affiliations:
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
Correspondence: Marc Righini, Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospital and Faculty of Medicine, 4, rue Gabrielle‐Perret‐Gentil, CH‐1211 Geneva 14, Switzerland|Tel.: +41 22372 9294|E‐mail:
,
Helia Robert‐Ebadi
Affiliations:
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Frédéric Glauser
Affiliations:
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Marc Blondon
Affiliations:
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Pierre Ouvry
Affiliations:
Vascular Physician, St. Aubin sur Scie, France
,
Jean‐Marc Diamand
Affiliations:
Vascular Physician, Grenoble, France
,
Anne Tissot
Affiliations:
Clinique du Tonkin, Villeurbanne, France
,
Paul Frappe
Affiliations:
Département de Médecine Générale and EA 3065, Saint‐Etienne University Hospital, Saint‐Etienne, France
,
Isabelle Quere
Affiliations:
Clinical Investigation Centre and Department of Internal and Vascular Medicine, Montpellier University Hospital, Montpellier, France
,
Susan R. Kahn
Affiliations:
Department of Medicine and Lady Davis Institute, Jewish General Hospital, Montreal, Canada
,
Jean‐Philippe Galanaud
Affiliations:
Clinical Investigation Centre and Department of Internal and Vascular Medicine, Montpellier University Hospital, Montpellier, France. Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
Grégoire Le Gal
Affiliations:
Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada
ISTH Academy. Righini M. Mar 1, 2019; 273398
Prof. Dr. Marc Righini
Prof. Dr. Marc Righini
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Journal Abstract
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Background
The optimal management of distal deep vein thrombosis (DVT) is highly debated. The only available placebo‐controlled trial suggested the absence of clear benefit of anticoagulation. Many physicians feel that, beyond preventing thromboembolic complications, anticoagulation with low‐molecular‐weight heparin (LMWH) has the potential to improve pain control.
Objectives
To analyze whether LMWHs decrease pain in patients with distal deep vein thrombosis.
Patients and methods
Two‐hundred and fifty‐two patients included in a multicenter, placebo‐controlled, randomized clinical trial of LMWH in patients with acute distal DVT and who were asked to rate their pain at inclusion and at each medical visit, using a visual analogue pain scale (VAS).
Results
One hundred and thirty patients were randomized in the therapeutic nadroparin arm and 122 patients were randomized in the placebo arm. Mean VAS values were 4.6 (standard deviation [SD] 2.5) at inclusion, 2.1 (SD 2.0) at 1 week and 0.4 (SD 1.2) at 6 weeks. We calculated the individual variation in VAS between inclusion and 1 week in patients in whom VAS was available at the two study time‐points. There was no difference in the mean VAS reduction between patients treated with therapeutic nadroparin (n = 106) and with placebo (n = 109): −2.6 (SD 2.4) vs. −2.3 (SD 2.0) after 1 week and −4.4 (SD 2.8) vs. −4.0 (SD 2.4) after 6 weeks, respectively. The use of compression stockings was associated with a reduction in pain.
Conclusion
These data suggests that LMWH use does not improve pain control as compared with placebo in patients with acute distal DVT.
Keyword(s)
distal deep vein thrombosis, low‐molecular‐weight heparin, pain, visual analogue pain scale
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