Veno-active drugs in the management of chronic venous disease. An international consensus statement: Current medical position, prospective views and final resolution
Affiliations: Angiologie & Dermatologie, Place Benjamin Constant 2, 1003 Lausanne, Switzerland | Université Victor Segalen Bordeaux 2, Département de Pharmacologie, 33076 Bordeaux, France | Department S.Giovanni Hospital, President UIP, Via S.Giovanni in Laterano 155, 00184 Rome, Italy | The Cyprus Institute of Neurology and Genetics, International Airport Avenue, 1683 Nicosia, Cyprus | Department of Angiology, University Hospital, Basel, CH-4031, Switzerland | Médecine Vasculaire, Hôpital Michallon, BP 217X, 38043 Grenoble cedex, France | Dipartimento di Medicina Interna, Cardiovascolare e Geriatrica, Università di Siena, Policlinico Santa Maria alle Scotte, Viale Bracci, 53100 Siena, Italy
Abstract: Background: Veno-active drugs (VAD) have effects on edema and symptoms related to chronic venous disease (CVD), especially so-called venous pain. VAD's effectiveness, although well established, is regularly debated. Objective: Our purpose was to select all randomized controlled trials (RCTs) and meta-analyses devoted to VAD and symptoms in CVD, to submit them to a group of international experts in CVD and to vote with secrete ballot to determine the level of efficacy of each drug, according to EBM (Evidence-Based Medicine) rules and critical analysis. Methods: Publications in any language devoted to VAD and venous symptoms were searched for in different databanks and submitted to the experts prior to the meeting. Results: 83 papers were analyzed, including 72 RCTs or meta-analyses. Experts determined the level of EBM of each drug, according to the literature and personal experience, using 3 levels of recommendation, A, B and C (from large RCTs to non-randomized trials). Conclusions: VAD are effective and may be applied in CVD when symptomatic, from C0s to C6s. However, etiological treatment of venous reflux and venous hypertension has always priority. In some cases VAD may replace compression and/or complement its effects. If respecting these prerequisites, VAD are safe and effective.
