beta-escin and Thrombophlebitis

Although superficial thrombophlebitis of the upper extremity represents a frequent complication of intravenous catheters inserted into the peripheral veins of the forearm or hand, no consensus exists on the optimal management of this condition in clinical practice.. To summarise the evidence from randomised clinical trials (RCTs) concerning the efficacy and safety of (topical, oral or parenteral) medical therapy of superficial thrombophlebitis of the upper extremity.. The Cochrane Vascular Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (2015, Issue 3). Clinical trials registries were searched up to April 2015.. RCTs comparing any (topical, oral or parenteral) medical treatment to no intervention or placebo, or comparing two different medical interventions (e.g. a different variant scheme or regimen of the same intervention or a different pharmacological type of treatment).. We extracted data on methodological quality, patient characteristics, interventions and outcomes, including improvement of signs and symptoms as the primary effectiveness outcome, and number of participants experiencing side effects of the study treatments as the primary safety outcome.. We identified 13 studies (917 participants). The evaluated treatment modalities consisted of a topical treatment (11 studies), an oral treatment (2 studies) and a parenteral treatment (2 studies). Seven studies used a placebo or no intervention control group, whereas all others also or solely compared active treatment groups. No study evaluated the effects of ice or the application of cold or hot bandages. Overall, the risk of bias in individual trials was moderate to high, although poor reporting hampered a full appreciation of the risk in most studies. The overall quality of the evidence for each of the outcomes varied from low to moderate mainly due to risk of bias and imprecision, with only single trials contributing to most comparisons. Data on primary outcomes improvement of signs and symptoms and side effects attributed to the study treatment could not be statistically pooled because of the between-study differences in comparisons, outcomes and type of instruments to measure outcomes.An array of topical treatments, such as heparinoid or diclofenac gels, improved pain compared to placebo or no intervention. Compared to placebo, oral non-steroidal anti-inflammatory drugs reduced signs and symptoms intensity. Safety issues were reported sparsely and were not available for some interventions, such as notoginseny creams, parenteral low-molecular-weight heparin or defibrotide. Although several trials reported on adverse events with topical heparinoid creams, Essaven gel or phlebolan versus control, the trials were underpowered to adequately measure any differences between treatment modalities. Where reported, adverse events with topical treatments consisted mainly of local allergic reactions. Only one study of 15 participants assessed thrombus extension and symptomatic venous thromboembolism with either oral non-steroidal anti-inflammatory drugs or low-molecular-weight heparin, and it reported no cases of either. No study reported on the development of suppurative phlebitis, catheter-related bloodstream infections or quality of life.. The evidence about the treatment of acute infusion superficial thrombophlebitis is limited and of low quality. Data appear too preliminary to assess the effectiveness and safety of topical treatments, systemic anticoagulation or oral non-steroidal anti-inflammatory drugs.

Topics: Anti-Inflammatory Agents; Anticoagulants; Catheterization, Peripheral; Dalteparin; Diclofenac; Drug Combinations; Drugs, Chinese Herbal; Escin; Gels; Heparin; Heparinoids; Humans; Ibuprofen; Nitroglycerin; Pentosan Sulfuric Polyester; Phospholipids; Polydeoxyribonucleotides; Randomized Controlled Trials as Topic; Thrombophlebitis; Upper Extremity

The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG), in comparison with placebo and with a group of controls in 23 patients with superficial vein thrombophlebitis (SVTPH) of the arms. SVTPH was consequent to infusional treatment with an intravenous catheter. The 4-week study evaluated the average skin temperature and an analogue symptomatic score. In patients treated with active EG, the decrease in score and in composite skin temperature was significantly larger than in the placebo and control groups. No intolerance was observed. The decrease in score and temperature in the placebo group was mainly due to skin manipulation and massage and to spontaneous resolution. In conclusion treatment with EG in arm SVTPH improves signs /symptoms and decreases skin temperature faster. This study confirms earlier observations on the effective, local use of EG in SVTPH.

Topics: Administration, Topical; Arm; Drug Combinations; Escin; Female; Fibrinolytic Agents; Heparin; Humans; Male; Middle Aged; Phospholipids; Skin Temperature; Thrombophlebitis

Eight prospective, controlled, randomised studies on the incidence of postoperative thrombosis in gynaecological patients receiving various drugs for prevention of thromboembolism are analysed. In all patients diagnosis had been established by objective means. The rate of thrombosis in patients without drug prophylaxis has been found to vary between 14 and 29%. Infusions of dextran as well as administration of low-dose subcutaneous heparin significantly reduce the incidence of deep vein thrombosis, even as compared to postoperative oral anticoagulation with cumarins. No difference has been found between dextran and oral anticoagulants, when cumarin adminstration was started before operation, nor between dextran and heparin. Aescin did not show any prophylactic effect. High age, severe leg-vein varicosis as well as surgery for malignant disease increase the risk of thrombosis. No significant influence of overweight, previous deep venous thrombosis, epidural anaesthesia or vaginal operation as compared to abdominal approach could be demonstrated. There are no properly controlled, prospective, randomised studies on the incidence of postoperative fatal pulmonary embolism as influenced by drugs in gynaecological surgery.

Topics: Age Factors; Anesthesia; Dextrans; Escin; Female; Genital Diseases, Female; Heparin; Humans; Obesity; Postoperative Complications; Thromboembolism; Thrombophlebitis; Varicose Veins

Topics: Acute Disease; Adult; Drug Combinations; Drug Evaluation; Escin; Female; Gels; Heparin; Humans; Male; Middle Aged; Phospholipids; Postoperative Care; Postphlebitic Syndrome; Thrombophlebitis; Varicose Veins

Clinical presentation of acute thrombophlebitis affecting lower limbs, classification of its forms and the response of the patients to essaven-gel are reviewed. Indications to such treatment are provided. High efficacy of essaven-gel is stated.

Topics: Acute Disease; Adult; Aged; Drug Combinations; Drug Evaluation; Escin; Female; Fibrinolytic Agents; Gels; Heparin; Humans; Male; Middle Aged; Phospholipids; Thrombophlebitis

Topics: Drug Combinations; Edema; Escin; Heparin; Humans; Leg; Rutin; Saponins; Thrombophlebitis; Varicose Veins; Venous Insufficiency

Topics: Drug Evaluation; Escin; Female; Humans; Male; Phosphatidylcholines; Rutin; Saponins; Thrombophlebitis; Varicose Veins; Venous Insufficiency

Essaven Gel contains aescin, heparin and essential phospholipids (EPL). It was administered locally in 15 patients suffering from thrombotic inflammation of tibial superficial veins. The effect of Essaven Gel on prostaglandin synthetase activity was also studied. In 12 patients a positive result was obtained in the form of anti-inflammatory action, diminution of pain, edema, excessive warmth and flushing. The anti-inflammatory action proceeds without any participation of prostaglandin synthetase.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Cyclooxygenase Inhibitors; Drug Combinations; Escin; Female; Gels; Heparin; Humans; Male; Middle Aged; Mixed Function Oxygenases; Phospholipids; Saponins; Thrombophlebitis

Topics: Aesculus; Anticoagulants; Crataegus; Drug Combinations; Escin; Hesperidin; Humans; Lower Extremity; Phosphatidylcholines; Plant Extracts; Thrombophlebitis; Thrombosis

Topics: Aesculus; Capillary Permeability; Escin; Flavonoids; Rats; Saponins; Thrombophlebitis; Varicose Veins

Topics: Aesculus; Erysipelas; Escin; Esophageal and Gastric Varices; Humans; Kidney Diseases; Leg Ulcer; Myocarditis; Thrombophlebitis; Thrombosis; Varicose Veins

Topics: Aesculus; Drug Combinations; Escin; Flavones; Flavonoids; Humans; Phospholipids; Thrombophlebitis; Thrombosis; Varicose Veins

Topics: Aesculus; Anticoagulants; Drug Combinations; Escin; Humans; Phlebitis; Plant Extracts; Pregnancy; Pregnancy Complications; Thiamine; Thrombophlebitis

Topics: Anticoagulants; Drug Combinations; Escin; Humans; Plant Extracts; Prognosis; Thrombophlebitis

Topics: Drug Combinations; Escin; Humans; Plant Extracts; Thrombophlebitis; Thrombosis