Official Journal of the Italian Society of Orthopaedics and Traumatology
Table 1 Summary of reviewed articles
From: Evidence for treatment of muscular vein thrombosis in orthopaedic patients
Author | n | Study type | Population | Investigating | Outcome | Recommendations | Drawbacks | Overall for or against treating as per DVT |
|---|---|---|---|---|---|---|---|---|
Gillet et al. [9] | 128 | Prospective observational study | Mixed outpatients | Rate of propagation in patients with therapeutic anticoagulation | 18.8 % recurrence of VTE (including MVT) by 36 months; No recurrence occurred whilst on treatment | Need for standardisation of treatment | Asymptomatic MVT patients excluded | For |
MacDonald et al. [10] | 135 | Prospective observational study | Mixed patients | Rate of propagation in patients without treatment | 3 % rate of propagation to popliteal veins; No propagation to thigh veins or cases of PE; 90 % of propagation occurred within 2 weeks | Follow-up imaging beyond 2 weeks may not be necessary | Single-centre study | Against |
Labropoulos et al. [11] | 48 | Prospective observational study | Mixed patients | Rate of propagation | When comparing DVT with MVT, the rate of propagation was similar | None | Small numbers | For |
Schwarz et al. [12] | 84 | Randomized prospective | Mixed patients | Treatment vs. no treatment monitored for propagation | Rate of propagation 25 % less in those treated with 10 days of heparin | No benefit from compression stockings and LMWH vs. compression therapy alone in MVT patients | Small numbers; Largely ambulatory patient group (89 % outpatients) | Against |
Sales et al. [13] | 141 | Non-randomised retrospective | Mixed inpatients | Treatment vs. no treatment monitored for propagation | No difference in rate of propagation when comparing treatment with no treatment | No difference in thrombus progression when comparing treatment with anticoagulation; Patients with other risk factors were more likely to show progression (ESRD, stroke) | Non-randomised; Ignored those patient who had isolated MVT but did not return for a subsequent scan | For |
Lautz et al. [15] | 406 | Non-randomised retrospective | Mixed patients | Rate of propagation | 10.4 % incidence of MVT; 19 % developed subsequent VTE; Significantly reduced by therapeutic (but not prophylactic) treatment | Therapeutic anticoagulation for MVT | Ignored the large proportion of patients with MVT who did not return for a subsequent scan (42 %) | For |
Galanaud et al. [14] | 390 | Non-randomised retrospective | Mixed patients | Presenting symptoms; Rate of propagation | No difference in rate of propagation when comparing MVT with DVT | Consider DVT and MVT a homogeneous entity | Heterogeneous population from several centres; non-randomisation resulted in MVT being treated on fewer occasions than DVT (P = 0.003) | For |
Wang et al. [16] | 359 | Non-randomized prospective | TKR patients | Incidence in orthopaedic patients; Rate of propagation | Rate of propagation similar when comparing DVT with MVT; Treatment made no difference to rates of DVT, propagation or PE | MVT should be considered comparable to DVT and treated as such | Stated as patient randomised to treatment, but not truly randomised; Conclusions drawn from differences in treatment groups are therefore flawed | For |