[Iluhin]

Хоть вопрос и не ко мне, я позволю себе небольшую ремарку.

На сегодняшний день исследования по флеботропным средствам систематизированы в Кохрановском обзоре:

Cochrane Database Syst Rev. 2005 Jul 20;(3):CD003229.
Phlebotonics for venous insufficiency.
Martinez MJ, Bonfill X, Moreno RM, Vargas E, Capellà D.

Abstract
OBJECTIVES: To assess the efficacy of oral or topical phlebotonics.

SEARCH STRATEGY: We searched the Cochrane Peripheral Vascular Diseases Group trials register (April 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (January 1966 to April 2005), EMBASE (January 1980 to April 2005) and reference lists of articles. We also contacted pharmaceutical companies.

SELECTION CRITERIA: Randomised, double blind, placebo-controlled trials (RCTs) assessing the efficacy of rutosides, hidrosmine, diosmine, calcium dobesilate, chromocarbe, centella asiatica, disodium flavodate, french maritime pine bark extract, grape seed extract and aminaftone in CVI patients at any stage of the disease.


MAIN RESULTS: Fifty-nine RCTs of oral phlebotonics were included, but only 44 trials involving 4413 participants contained quantifiable data for the efficacy analysis: 23 of rutosides, ten of hidrosmine and diosmine, six of calcium dobesilate, two of centella asiatica, one of french maritime pine bark extract, one of aminaftone and one of grape seed extract. No studies evaluating topical phlebotonics, chromocarbe, naftazone or disodium flavodate fulfilled the inclusion criteria. Outcomes included oedema, venous ulcers, trophic disorders, subjective symptoms (pain, cramps, restless legs, itching, heaviness, swelling and paraesthesias), global assessment measures and side effects. The results of many variables were heterogeneous. Phlebotonics showed some global benefit (i.e. oedema reduction) (relative risk 0.72, 95% confidence interval 0.65 to 0.81). The benefit for the remaining CVI signs and symptoms must be evaluated by phlebotonic group. There were no quantifiable data on quality of life.

AUTHORS' CONCLUSIONS: There is not enough evidence to globally support the efficacy of phlebotonics for chronic venous insufficiency. There is a suggestion of some efficacy of phlebotonics on oedema but this is of uncertain clinical relevance. Due to the limitations of current evidence, there is a need for further randomised, controlled clinical trials with greater attention paid to methodological quality.

более подробно в тексте обзора представлен анализ по всем рассматриваемым симптомам. например, боль:

(2) Assessment of CVI symptoms
(a) Pain
(i) Dichotomous variable
Twenty trials were included in the analysis: ten on rutosides, four on calcium dobesilate, four on diosmine and hidrosmine, one on aminaftone and one on french maritime pine bark extract, with a total of 1294 participants treated with phlebotonics and 953 treated with placebo. The results were heterogeneous.
(ii) Continuous variable
Six studies were included in the analysis: three on rutosides, one on calcium dobesilate, one on diosmine and one on french maritime pine bark extract, with a total of 244 participants assigned to phlebotonic agents and 231 participants assigned to placebo. The outcome was heterogeneous.

При этом, обратите внимание на оценку качества включенных исследований и вероятность систематичеких ошибок:

Quality levels
If we applied the quality criteria specified in the Cochrane Handbook, only two studies ( Dominguez 1992; Vanscheidt 2002a) would be at level A (low risk of bias), while most other studies would be level B (moderate risk of bias) (see ).

Становятся понятными выводы авторов по эффективности флеботропных средств в отношении отдельных симптомов ХВН:

Some specific groups of phlebotonics show a measure of efficacy for certain symptoms and signs but given the limited number of studies and the discordance in their results, it is not possible to interpret the clinical relevance of these findings.