Meta-analysis of the impact of the principal venoactive drugs agents on malleolar venous edema.
OBJECTIVE
The aim of this study was to compare the reduction of venous ankle edema in randomized controlled trials of the main venoactive drugs versus a placebo or versus another venoactive drug and thereby to confirm or invalidate the existing recommendations on the pharmacological treatment of venous edema.


METHODS
Publications of randomized controlled trials of venoactive drugs versus either a placebo or another venoactive drug on the reduction of ankle circumferences (AC) were searched through Medline and selected according to the Jadad and the Cucherat evaluation grids.


RESULTS
Ten publications dated between 1975 and 2009 including a total of 1010 patients were identified for the meta-analysis. Included were the following venoactive drugs: micronised purified flavonoid fraction (MPFF), hydroxyethylrutoside, ruscus extracts and diosmin. The mean reduction in AC was -0.80 ± 0.53 cm with MPFF , -0.58 ± 0.47 cm with ruscus extract, -0.58 ± 0.31 cm with hydroxyethylrutoside, -0.20 ± 0.5 cm with single diosmin, and -0.11 ± 0.42 cm with placebo. The reduction in AC was significantly superior to that of placebo whatever the drug concerned (P<0.0001). The comparison between MPFF, ruscus extract and hydroxyethylrutoside on the reduction of ankle edema was in favour of MPFF. This was significant (P<0.0001), while the efficacy of the latter two venoactive agents was comparable.


CONCLUSIONS
This meta-analysis confirms the validity of the grade A assigned to MPFF in the management of symptoms and edema in recent international guidelines.
Ceren ESC and Dijon University Hospital, Dijon, France. allaert@cenbiotech.com
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Allaert
D000842:Ankle / Q000098:blood supply*; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D004487:Edema / Q000188:drug therapy* / Q000473:pathology; D019317:Evidence-Based Medicine; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014680:Veins / Q000187:drug effects; D014689:Venous Insufficiency / Q000188:drug therapy* / Q000473:pathology
D002317:Cardiovascular Agents