Low prevalence of Post-thrombotic syndrome in patients treated with rivaroxaban.

Post-thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT). Residual vein thrombus (RVT) on Doppler Ultrasound can be associated with PTS. Limited data are available on the effect of direct oral anticoagulants (DOACs) on the long-term outcome of PTS. This study aimed to compare the prevalence of PTS and RVT, in patients with previous DVT treated with rivaroxaban or enoxaparin/warfarin. A total of 129 patients with previous proximal lower limb DVT and treated with rivaroxaban (n = 71) or enoxaparin/warfarin (n = 58) for at least 3 months were included. The Villalta scale for PTS was performed after treatment. The median duration of the DVT symptoms before anticoagulation was 7 days for both groups. The rate of PTS was 50.7% in the patients treated with rivaroxaban and 69% in the enoxaparin/warfarin group. Enoxaparin/warfarin showed an increased prevalence of PTS (P = .018). An analysis in 3 different models showed that the relative risk of PTS decreased by 76% with rivaroxaban use when compared with enoxaparin/warfarin treatment. In addition, 93 of the 129 patients were evaluated regarding the presence of RVT, of which, 11 (24.4%) and 31 (64.6%) presented with RVT for rivaroxaban and enoxaparin/warfarin, respectively (P < .0001). The RVT analysis excluded the possibility of RVT as a mediator of the association between type of treatment and PTS when comparing rivaroxaban with enoxaparin/warfarin (odds ratio (OR) = 0.14; 95% confidence interval (CI): 0.1-1.0, P = .051) with rivaroxaban compared with enoxaparin/warfarin. Rivaroxaban treatment was associated with a lower risk of PTS when compared to enoxaparin/warfarin; RVT however, was not a mediator in the association between PTS and type of treatment.

Facial edema reduction after alveolar bone grafting surgery in cleft lip and palate patients: a new lymphatic drainage protocol / Redução do edema facial após cirurgia de enxerto ósseo alveolar em pacientes com fissura labiopalatina: um novo protocolo de drenagem linfática

Objective: To determine the effectiveness of standardized manual lymphatic drainage in reducing facial edema, interincisal distance and pain after alveolar bone grafting surgery in patients with cleft lip and palate.Methods: In this randomized open controlled parallel trial, 51 patients with cleft lip and palate submitted to after alveolar bone grafting were randomlydivided into two groups: 1) routine group (n=22): manual lymphatic drainage performed by the patient, pumping and sliding maneuvers, for10 minutes, 3 times/day, on the operated hemiface, and, 2) drainage group (n=29): manual lymphatic drainage performed by the physical therapist, pumping, sliding and stationary cycles maneuvers, for 30 minutes, on both sides of the face. Interincisal distance and lines formed between the nasal ala and tragus (L1) and between the nasal ala and inferior region of the ear (L2) were assessed on the operated hemiface, preoperatively, two (PO2) and four days postoperatively (PO4). Pain analog scale was applied on PO1, PO2, PO3 and PO4. Results: A significant reduction in facial edema from PO2 to PO4 was observed in drainage group (L1:11.50 to 11.38cm; L2:11.06 to 10.85cm) compared to routine group; interincisal distance increased significantly in both groups from PO2 to PO4 (routine group: 1.91 to 3.14cm; drainage group: 1.99 to 3.17cm, respectively). Drainage group patients reported absence of pain on PO3 while routine group patients only on PO4. Conclusion: The proposed manual lymphatic drainage procedure provided significant reduction in facial edema reduction, in pain, and interincisal distance increase, reinforcing the hypothesis that this technique was effective in accelerating the recovery of patients with cleft lip and palate undergoing alveolar bone grafting surgery. Brazilian Register of Clinical Trials: RBR-4z7cnh.

Objetivo: Determinar a eficácia da drenagem linfática manual na redução do edema facial, da distância interincisal e da dor após cirurgia de enxertoósseo alveolar em pacientes com fissura labiopalatina. Métodos: Estudo paralelo controlado randomizado aberto de 51 indivíduos com fissura labiopalatina, submetidos ao enxerto ósseo alveolar, divididos aleatoriamente em 2 grupos: 1) grupo rotina (n=22), realizada pelo paciente, utilizando manobras de bombeamento e deslizamento, por 10minutos, 3 vezes/dia, na hemiface operada, e, 2) grupo drenagem padronizada (n=29), realizada pelo fisioterapeuta, utilizando manobras debombeamento, deslizamento e círculos estacionários, por 30 minutos, nos dois lados da face. Distância interincisal e as linhas formadas pelaunião de pontos localizados na asa nasal e tragus (L1) e asa nasal e região inferior do ouvido (L2) foram aferidas na hemiface operada no préoperatório, nos pós-operatórios de dois (PO2) e quatro dias (PO4). Aplicou-se Escala Analógica de Dor nos PO1, PO2, PO3 e PO4.Resultados: Observou-se redução significativa do edema no grupo drenagem padronizada entre PO2 e PO4 (L1: 11,50 para 11,38cm; L2: 11,06 para 10,85cm) e aumento significativo na distância interincisal nos 2 grupos entre PO2 e PO4 (RG: 1,91 para 3,14cm; drenagem padronizada: 1,99 para 3,17cm, respectivamente). Ausência de dor foi relatada pelo grupo drenagem padronizada no PO3 e pelo grupo rotina no PO4.Conclusão: A drenagem linfática manual proposta reduziu significantemente o edema facial, a dor e aumentou a distância interincisal quando comparado ao grupo rotina, reforçando a hipótese que a técnica proposta acelerou a recuperação de pacientes com fissura labiopalatina submetidos à cirurgia de enxerto ósseo alveolar. Registro Brasileiro de Ensaios Clínicos: RBR-4z7cnh.