Residual vein thrombosis to establish duration of anticoagulation after a first episode of deep vein thrombosis: the Duration of Anticoagulation based on Compression UltraSonography (DACUS) study.

Residual vein thrombosis (RVT) indicates a prothrombotic state and is useful for evaluating the optimal duration of oral anticoagulant treatment (OAT). Patients with a first episode of deep vein thrombosis, treated with OAT for 3 months, were managed according to RVT findings. Those with RVT were randomized to either stop or continue anticoagulants for 9 additional months, whereas in those without RVT, OAT was stopped. Outcomes were recurrent venous thromboembolism and/or major bleeding. Residual thrombosis was detected in 180 (69.8%) of 258 patients; recurrent events occurred in 27.2% of those who discontinued (25/92; 15.2% person-years) and 19.3% of those who continued OAT (17/88; 10.1% person-years). The relative adjusted hazard ratio (HR) was 1.58 (95% confidence interval [CI], 0.85-2.93; P = .145). Of the 78 (30.2%) patients without RVT, only 1 (1.3%; 0.63% person-years) had a recurrence. The adjusted HR of patients with RVT versus those without was 24.9 (95% CI, 3.4-183.6; P = .002). One major bleeding event (1.1%; 0.53% person-years) occurred in patients who stopped and 2 occurred (2.3%; 1.1% person-years) in those who continued OAT. Absence of RVT identifies a group of patients at very low risk for recurrent thrombosis who can safely stop OAT. This trial was registered at http://www.ClinicalTrials.gov as no. NCT00438230.

[The ambulatory treatment of varicose veins pathology. Personal experience]. / Il trattamento ambulatoriale della patologia varicosa: esperienza personale.

OBJECTIVE: In time of Surgery Cost Planning, progress is every step to ward an efficient and complete ambulatory treatment of pathology. In the field of venous surgery, a large share of patients take profit from a complete treatment in a single hospitalisation day. MATERIALS: The Authors carried out 21 strippings of great saphenous vein in 21 patients with local and regional anaesthesia. RESULTS: The results were the same as those of the traditional operation carried out with the help of spinal anaesthesia for a greater safety and comfort of the surgeons action. Moreover the authors obtained an immediate take off of the patient and his discharging after a few hours under observation. COMMENTS: The particular surgery technique perfectly copes with the anaesthetic method and fully profits from it because it limits local complication and unacceptable aesthetic defects. The chosen anaesthetic technique and the early take off haven't brought to any complications; moreover subcutaneous bleeding has been reduced, due to the absence of vasoparalysis typical of spinal anaesthesia.