Anti-inflammatory effects of diosmin as adjunctive therapy in acute deep vein thrombosis: Impact on venous recanalization,quality of life and post-thrombotic syndrome

Abstract

Background

Deep vein thrombosis (DVT) is associated with inflammatory response that may contribute to incomplete venous recanalization and post-thrombotic syndrome (PTS). Diosmin, a venoactive flavonoid, may provide additional benefit when combined with standard anticoagulation.

Objectives

To evaluate whether adjunctive diosmin therapy reduces inflammation, improves recanalization, enhances quality of life, and decreases PTS severity in acute DVT.

Methods

This retrospective cohort study analyzed 612 patients with acute proximal DVT receiving anticoagulation alone (control, n = 298) or anticoagulation plus diosmin 600 mg daily (n = 314). Propensity score matching (1:1) yielded 230 pairs. C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and erythrocyte sedimentation rate (ESR) were assessed at baseline and day 30. Recanalization was evaluated by duplex ultrasound at 3 and 12 months. Quality of life was measured using VEINES-QOL, and PTS was assessed using the Villalta scale at 12 months.

Results

The diosmin group showed greater reductions in CRP (−13.9 vs −11.8 mg/L; p = 0.038), NLR (−1.72 vs −1.43; p = 0.019), and ESR (−17.2 vs −14.1 mm/hr; p = 0.031) at day 30. Complete recanalization rates were higher with diosmin at 12 months (91.3% vs 76.5%; p < 0.001). VEINES-QOL scores were better in the diosmin group at 12 months (71.8 ± 13.2 vs 66.9 ± 12.6; p = 0.024). While overall PTS incidence was similar (14.9% vs 16.3%; p = 0.72), moderate-to-severe PTS was less frequent with diosmin among PTS patients (21% vs 40%; Fisher’s exact p = 0.062), suggesting a trend that requires confirmation.

Conclusions

Adjunctive diosmin was associated with greater inflammatory marker reductions, improved recanalization, and better quality of life. A trend toward reduced PTS severity was observed but should be interpreted cautiously given the small number of events. Prospective randomized trials are needed to confirm these findings.

Keywords

deep vein thrombosis diosmin post-thrombotic syndrome venous recanalization quality of life inflammatory markers C-reactive protein

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