Elastic Compression Stockings and the risk of post-thrombotic syndrome (PTS) in patients with symptomatic proximal vein thrombosis
Date First Published:
March 1, 2000
Last Updated:
May 11, 2001
Report by:
Beverly Lane, Research Nurse (Manchester Royal Infirmary)
Search checked by:
Steve Jones, Manchester Royal Infirmary
Three-Part Question:
In [patients with confirmed deep vein thrombosis] does [the use of compression stockings] reduce [the risk of post-thrombotic syndrome (PTS)]?
Clinical Scenario:
A 35 year old woman attends the Emergency Department with a swollen and painful left leg. A DVT is suspected and confirmed on ultrasound. You are aware of the possible risks of developing post-thrombotic syndrome and wonder whether this young woman would benefit from the use of compression stockings.
Search Strategy:
Medline 1966-07/00 using the OVID interface.
Search Details:
{(Exp.thrombosis OR venous thrombosis OR thrombosis.mp) AND {exp.stockings.mp) OR exp.TED stockings.mp OR exp. support stockings.mp OR exp. compression stockings.mp OR {exp.graduated compression stockings.mp}. Limit to english language AND human.
Outcome:
19 papers found of which 18 were irrelevant or of insufficient quality for inclusion. The remaining paper is shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Randomised trial of effect of compression stockings in patients with symptomatic proximal vein thrombosis. Brandjes D, Buller HR, Heijboer H, et al. 1997, Holland | 194 consecutive patients with a first episode of proximal DVT(proved on venogram). Custom fitted graduated compression stockings (96), vs no stockings(98). Assessment every 3 months for 2 years, and thereafter every 6 months for at least 5 years. |
PRCT | Incidence of PTS | Mild to moderate PTS occurred in 19 patients in the stocking group and in 46 patients in the control group(P=<0.001) | Due to the non blinded design, potential bias in the assessment of post- thrombotic syndrome Lack of an accepted definition of PTS |
| PTS was assessed using clinical characteristics and leg measurements | 11 patients in the stocking group developed severe PTS compared with 23 in the control group(P=<0.001) |
Author Commentary:
The incidence of PTS following confirmed DVT is unknown but it has been reported to be between 20 and 100%. This wide range probably reflects the small size of these retrospective studies with different periods of follow up and selection criteria. Interpretation of the findings from these studies is also hampered by the lack of objective diagnostic criteria for PTS.
Bottom Line:
Elastic Compression Stockings should be used within 2 weeks of onset of acute thrombotic event and worn for up to 2 years.
References:
- Brandjes D, Buller HR, Heijboer H, et al.. Randomised trial of effect of compression stockings in patients with symptomatic proximal vein thrombosis.