Standardized seed extract; its active compound tightens vein walls and slows fluid leakage. Best supported: less lower-leg swelling, pain, aching, and heaviness where leg veins no longer return blood efficiently. Itching relief and hemorrhoidal bleeding control rest on thinner ground. Stomach irritation is the main cost, largely solved by slow-release forms taken with food. Raw seeds are poisonous. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Ankle circumference | Within 0.5 cm of morning baseline by evening | Primary objective response measure |
| Lower-leg volume | Toward individual baseline; a 30–50 mL fall is the trial-level effect | Endpoint used in all pivotal trials |
| Venous Clinical Severity Score (VCSS) | 0–3 (asymptomatic to mild) | Captures pain, edema, skin changes in one number |
| Ankle-brachial index (ABI) | 1.00–1.30 | Determines whether compression is safe to add |
| Alanine aminotransferase (ALT) | <25 U/L men, <20 U/L women | Detects the rare hepatic signal |
| Estimated glomerular filtration rate (eGFR) | >90 mL/min/1.73 m² | Kidney clears escin metabolites |
| Platelet count | 175–250 × 10⁹/L | Baseline for the antiplatelet effect |
| International normalized ratio (INR) | Individual prescribed target, typically 2.0–3.0 on warfarin | Detects interaction with warfarin |
| High-sensitivity C-reactive protein (hs-CRP) | <1.0 mg/L | Tracks the inflammatory component escin targets |
| Serum albumin | 4.0–5.0 g/dL | Excludes low-protein edema, which escin cannot address |
Cadence: Symptom scoring and ankle measurement at 4 and 12 weeks; liver and kidney panels at 12 weeks, then every 6–12 months; clotting markers only on antiplatelet or anticoagulant therapy or a dose change