Diagnostic et traitement des varices des membres inférieurs - KCE
Diagnostic et traitement des varices des membres inférieurs - KCE
Diagnostic et traitement des varices des membres inférieurs - KCE
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32 Varicose Veins <strong>KCE</strong> Reports 164<br />
5.6 DRUGS<br />
5.6.1 One Cochrane review on the effect of phlebotonics for chronic venous<br />
insufficiency<br />
One Cochrane review (with database searches from 2005) has evaluated the use of oral<br />
phlebotonics for the treatment of chronic venous insufficiency (CVI) 37 . No paper has<br />
been found on the effect of these medications on varicose veins specifically.<br />
Fifty-nine RCTs were included in this review. They assessed the use of these drugs to<br />
improve the outcomes of oedema, venous ulcers, trophic disorders and subjective<br />
symptoms. This Cochrane review did not find evidence supporting the use of<br />
phlebotonics for CVI. The included RCTs in this review had several overall limitations.<br />
Firstly, diagnosis criteria and CVI definitions were often not used or reported, making<br />
the study populations h<strong>et</strong>erogeneous. Secondly, the study outcomes were not well<br />
reported in the studies. The results were not separated into the different stages of CVI<br />
which meant interpr<strong>et</strong>ation on the use of drugs for the treatment of varicose veins was<br />
limited.<br />
5.6.2 Lack of evidence in one RCT<br />
One RCT supported by the industry studied 509 patients with chronic venous disease<br />
randomised to calcium dobesilate or placebo during 3 months. This trial found no<br />
significant difference b<strong>et</strong>ween the groups for the main outcomes i.e. QoL, oedema and<br />
symptoms after three months. A significant overall improvement in QoL in both groups<br />
suggested a placebo effect 89 . An improvement in QoL was observed 9 months after the<br />
end of the treatment but this observation was based on a secondary analysis.<br />
Summary: drugs<br />
The studies on medications targ<strong>et</strong>ed chronic venous disease patient population<br />
rather than varicose vein patients specifically. Overall there is no evidence to<br />
support the effectiveness of phlebotonics.<br />
5.7 OTHER CONSERVATIVE TREATMENTS<br />
No systematic reviews or RCTs on other conservative treatments, such as exercise and<br />
weight loss for the treatment of varicose veins, were identified.