Volume 15, Number 3
www.venousdigest.com
March 2008
§ In Vitro Effects of Detergent Sclerosants on
Coagulation, Platelets and Microparticles
Parsi K, Exner T, Connor DE, Ma DDF, Joseph JE.
Eur J Vasc Endovas Surg 2007;34:731-740.
Abstract and Commentary by:
Mitchel P. Goldman, MD, La Jolla, CA
Two detergent sclerosing solutions, sodium tetradecyl sulfate
(STS) and polidocanol (POL) were evaluated with a variety of clotting
tests, clotting factors and microparticles in vitro. Both STS and POL
were found to interfere with clotting factor activities, procoagulant
phospohlipids and platelet derived microparticles. STS had more
anticoagulant activity than POL with concentrations > 0.3%. Proco-
agulant activity occurred with concentrations< 0.3%.
Since sclerosing solutions even if they are listed by their generic
name of POL or STS have a different composition with a different
percent of a variety of detergent contaminants, the results from this
excellent study only pertain to Fibrovein STS (STD Pharmaceuticals
Ltd.) and Aethoxysklerol POL (Chemische Fabrik Kreussler & Co
GmbH).
1
Interesting information with little clinical relevance include changes
in anticoagulant activity with prolonged exposure. Detergent scleros-
ing solutions are rapidly inactivated and bound by plasma proteins.
Any free POL and/or STS in veins after a few minutes is doubtful.
Commentary
What this reviewer found most interesting was the difference in
action on a variety of coagulation parameters between two detergent
sclerosing solutions. Clinically, the only difference phlebologists note
between POL and STS is that STS has twice the sclerosing effect.
Therefore, the clinical significance of the increase in anticoagulant
activity of STS over POL is not clear.
The most important finding was the procoagulant properties of
both agents with very dilute concentrations (<0.3%). This may be
one reason why multiple case reports of deep vein thrombosis (DVT)
have been reported with the treatment of leg telangiectasia <1mm in
diameter with concentrations of POL and STS < 0.25%.
2
Thus, even
when treating leg telangiectasia with dilute detergent solutions, the
use of graduated compression stockings and immediate ambulation
is recommended to prevent DVT.
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© 2008 John J. Bergan, MD, Inc.
Venous Digest, 9850 Genesee Avenue, Ste 410, La Jolla, CA (858) 550-0330
Page 1
Table of Contents
§ In Vitro Effects of Detergent
Sclerosants on Coagulatio n, Platelets a nd
Microparticles
Parsi K, Exner T, Connor DE, Ma DDF, Joseph JE.
Eur J Vasc Endovas Surg.
2007;34:731-740.
Abstract and Commentary by:
Mitchel P. Goldman, MD, La Jolla, CA
§ Classification of Compression
Bandages: Practical Aspects
Partsch H, Clark M, Mosti G, Steinlechner E, Schuren
J, Abel M, et al.
Dermatol Surg.
2008;34:1524-1535.
Abstract and Commentary by:
Joseph A. Caprini, MD, Evanston, Il
§ Evaluation an d Treatment of Varicose
Veins: The Immense Value of Duplex
Ultrasound Mapping
Eaton TL, Savickiene V.
Przeglad Flebologiczny
. 2007;15(3):97-102.
Abstract and Commentary by:
Alessandro Frullini, Florence, Italy
§ Endovenou s 9 80-nm Laser Treatmen t
o f Saphe nous Ve in s in a Serie s of 500
Patients
Desmyttére J, Grard C, Wassmer B, Mordon S.
J Vasc Surg.
2007;46:1242-7.
Abstract and Commentary by:
Neil Khilnani, MD, Ithaca, NY
§ Comparison of 1% and 3% Polidocanol
Foam in Ultraso und Guided Sclerotherapy
of the Great Saphenous Vein: A
Randomised, Double-Blind Trial with 2
Year-Follow-Up. ‘‘The 3/1 Study’’
Hamel-Desnos C, Oesnos P, Boitelle G, Schadeck M,
Desnos P, Allaert F-A.
Eur J Vasc Endovasc Surg.
2007;34:723-9;
discussion, 730.
Abstract and Commentary by:
JJ Guex, Nice, France
§ The Use of Intra vascular Ultrasound
Imaging to Improve Use of Inferior Vena
Cava Filters in a High-Risk Bariatric
Population
Kardys CM, Stoner MC, Manwaring ML, Bogey WM,
Parker FM, Powell S.
J Vasc Surg.
2007;46:1248-52.
Abstract and Commentary by:
Peter Henke, MD, Ann Arbor MI
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