Sage Journals: Discover world-class research

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

Get full access to this article

View all access options for this article.

References

Heit

. Epidemiology of venous thromboembolism. Nat Rev Cardiol 2015; 12: 464–474. https://doi.org/10.1038/nrcardio.2015.83

Raskob

Angchaisuksiri

Blanco

, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2014; 34: 2363–2371. https://doi.org/10.1161/ATVBAHA.114.304488

Kahn

Shrier

Julian

, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008; 149: 698–707. https://doi.org/10.7326/0003-4819-149-10-200811180-00004

Prandoni

Lensing

Cogo

, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125: 1–7. https://doi.org/10.7326/0003-4819-125-1-199607010-00001

Rabinovich

Kahn

. The postthrombotic syndrome: current evidence and future challenges. J Thromb Haemost 2017; 15: 230–241. https://doi.org/10.1111/jth.13569

Roumen-Klappe

den Heijer

van Uum

, et al. Inflammatory response in the acute phase of deep vein thrombosis. J Vasc Surg 2002; 35: 701–706. https://doi.org/10.1067/mva.2002.121746

Poredos

Jezovnik

. The role of inflammation in venous thromboembolism and the link between arterial and venous thrombosis. Int Angiol 2007; 26: 306–311.

Folsom

Lutsey

Astor

, et al. C-reactive protein and venous thromboembolism: a prospective investigation in the ARIC cohort. Thromb Haemost 2009; 102: 615–619. https://doi.org/10.1160/TH09-04-0274

Lyseng-Williamson

Perry

. Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs 2003; 63: 71–100. https://doi.org/10.2165/00003495-200363010-00005

10.

Nicolaides

. From symptoms to leg edema: efficacy of Daflon 500 mg. Angiology 2003; 54(Suppl 1): S33–S44. https://doi.org/10.1177/0003319703054001S05

11.

Bergan

Schmid-Schönbein

Coleridge Smith

, et al. Chronic venous disease. N Engl J Med 2006; 355: 488–498. https://doi.org/10.1056/NEJMra055289

12.

Shoab

Porter

Scurr

, et al. Effect of oral micronized purified flavonoid fraction treatment on leukocyte adhesion molecule expression in patients with chronic venous disease: a pilot study. J Vasc Surg 2000; 31: 456–461.

13.

Takase

Pascarella

Lerond

, et al. Venous hypertension, inflammation and valve remodeling. Eur J Vasc Endovasc Surg 2004; 28: 484–493. https://doi.org/10.1016/j.ejvs.2004.05.012

14.

Gloviczki

Comerota

Dalsing

, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines. J Vasc Surg 2011; 53(5 Suppl): 2S–48S. https://doi.org/10.1016/j.jvs.2011.01.079

15.

Gloviczki

Stoughton

Puggioni

, et al. Utility of venoactive compounds in post-thrombotic syndrome: a systematic review. J Vasc Surg Venous Lymphat Disord 2025; 13(4): 102228. https://doi.org/10.1016/j.jvsv.2025.102228

16.

Gloviczki

Kakkos

Urbanek

, et al. The role of venoactive compounds in the treatment of chronic venous disease. J Vasc Surg Venous Lymphat Disord 2025; 13(5): 102258. https://doi.org/10.1016/j.jvsv.2025.102258

17.

von

Altman

Egger

, et al. The STROBE statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453–1457.

18.

Vedantham

Goldhaber

Julian

, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 2017; 377: 2240–2252. https://doi.org/10.1056/NEJMoa1615066

19.

Henke

Wakefield

. Thrombus resolution and vein wall injury: dependence on chemokines and leukocytes. Thromb Res 2009; 123(Suppl 4): S72–S78. https://doi.org/10.1016/S0049-3848(09)70148-3

20.

Kahn

Shapiro

Wells

, et al. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 2014; 383: 880–888. https://doi.org/10.1016/S0140-6736(13)61902-9

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.09 MB

0.00 MB

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

Objectives

Methods

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material