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Horse-chestnut for chronic venous insufficiency

Clinical bottom line: Active and placebo controlled trials showed that horse-chestnut seed extract is effective in chronic venous insufficiency. Leg volume and circumference, and oedema were reduced.


Systematic review:

Pittler MH, Ernst E. Horse-chestnut for chronic venous insufficiency. A criteria-based systematic review. Archives of Dermatology 1998; 134: 1356-1360.



Date review completed: December 1996

Number of trials included: 13

Number of patients: (1083 total)

Control groups: placebo, active control.

Main outcomes: Leg volume or circumference, chronic venous insufficiency symptoms, capillary filtration coefficient.

Inclusion criteria were randomised, double blind, controlled trials which assessed the effectiveness of horse-chestnut seed extract (HCSE) for chronic venous insufficiency (CVI).

Medline, Embase, Biosis. AMED, CICSOM and the Cochrane Library were searched (to December 1996) using relevant key words. The reviewers' own files were searched for relevant studies. Bibliographies of retrieved reports were checked for additional citations and no language restrictions were made. Manufacturers of horse-chestnut seed extract products and experts were contacted for published and unpublished trials. Data were extracted in a standardised, predefined manner by the two reviewers who were blind to the author, journal, institution etc of the trials. Methodological quality was rated using a validated 5-point scale. A descriptive analysis was conducted.


Findings:

Thirteen studies were included; eight were placebo controlled (585 patients) and five used an active control (498 patients). Most studies used the following criteria for defining CVI: stage I (ankle oedema without trophic changes), stage II (oedema, hyperpigmented or depigmented areas, indurations), stage III (open or healed leg ulcer). Eleven studies assessed patients with stages I and II; three assessed patients with stages I to III.

Placebo controlled studies:

Eight placebo controlled studies assessed HCSE 100-150 mg per day over 4-12 weeks. Four studies used a cross-over design. The studies assessed leg volume (four), capillary filtration coefficient (one), leg circumference (one), and CVI symptoms. All studies showed HCSE to be more effective than placebo; the difference was significant in seven.

Active controlled studies:

Five active controlled studies assessed HCSE 100-150 mg per day over 2-8 weeks. Active control treatments were O-(b-hydroxyethyl)-rutosides. HCSE was significantly more effective than O-(b-hydroxyethyl)-rutosides for leg volume (two studies), ankle circumference (one) and leg circumference (one). There was no significant difference between HSCE and compression therapy for leg volume in one study.


Adverse effects

Adverse effects were uncommon (0.9-3% patients reported adverse effects). Gastrointestinal adverse effects, dizziness, pruritus, nausea and headache were reported.

 

Comment

These studies showed that HCSE is effective in treating chronic venous insufficiency, though some studies were small and different outcomes were assessed in a number of trials. Cross-over design was used in four placebo controlled trials. It is possible that cross over effects of previous treatment could have biased the results in the second treatment phase. The washout period was not stated by the reviewers.

 


Further reading


Related topics


AT133 Oedema protective drugs for chronic venous insufficiency

Identifier

AT132 - 5863 HORSE-CHESTNUT FOR CHRONIC VENOUS INSUFFICIENCY: Sep-2000