Clinical research study
Venous Compression for Prevention of Postthrombotic Syndrome: A Meta-analysis

https://doi.org/10.1016/j.amjmed.2010.01.027Get rights and content

Abstract

Purpose

To determine the effectiveness of venous compression stockings or compression bandages on the reduction of postthrombotic syndrome in patients with deep venous thrombosis.

Methods

We attempted to identify all published trials in all languages identified by PubMed through June 2009. Meta-analysis was performed.

Results

Based on 5 randomized trials of patients with deep venous thrombosis comparing treatment with venous compression to controls, mild-to-moderate postthrombotic syndrome occurred in 64 of 296 (22%) treated with venous compression, compared with 106 of 284 (37%) in controls (relative risk = 0.52). Severe postthrombotic syndrome occurred in 14 of 296 (5%) treated, compared with 33 of 284 (12%) controls (relative risk = 0.38). Any postthrombotic syndrome occurred in 89 of 338 (26%) treated, compared with 150 of 324 (46%) controls (relative risk = 0.54).

Conclusion

Venous compression reduced the incidence of postthrombotic syndrome, particularly severe postthrombotic syndrome. Venous compression in patients with deep venous thrombosis would seem to be indicated for this purpose. There was, however, wide variation in the type of stockings used, time interval from diagnosis to application of stockings, and duration of treatment. Further investigation, therefore, is needed.

Section snippets

Study Identification

We attempted to identify all published trials in all languages that used compression stockings to prevent the postthrombotic syndrome. Studies were identified by searching PubMed through June 2009. Key words in the literature search were: “postthrombotic syndrome” combined with “prevention,” “elastic stockings,” or “compression therapy.” We augmented our searches by manually reviewing the reference lists of all original articles and all review articles. This was done by 2 of the authors,

Results

Age and sex of the patients in the 5 included trials are shown in Table 1. Among 338 treated patients, below-knee stockings were used in 308 (91%) patients, thigh-length stockings in 17 (5%), and thigh bandages in 13 (4%).2, 3, 4, 5, 6 Characteristics of the stockings, time interval between diagnosis of deep venous thrombosis and application of stockings, duration of stocking use, duration of follow-up, the scoring system used, and the incidence of postthrombotic syndrome are shown in Table 2.

Discussion

The risk of postthrombotic syndrome, on average, was reduced 46% by venous compression, usually by below-knee compression stockings. Venous compression was more effective in reducing the incidence of severe postthrombotic syndrome (62% risk reduction) than mild-to-moderate postthrombotic syndrome (48% risk reduction). One investigation (Ginsberg et al)3 showed little benefit. In this investigation, the control patients received stockings that were 1-2 sizes too large.3 We speculate that the

Acknowledgment

We thank Muhammad Anis Musani, MD, for assisting in the literature search.

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    Citation Excerpt :

    Until recently, graduated elastic compression stockings were prescribed to prevent PTS in adults at risk [2]. Supporting their use, a pooled analysis of randomized controlled trials (RCT) conducted between the 1990s and the early 2000s [3–7] concluded that compression stockings reduced the incidence of PTS by 50% [8]. Despite their heterogeneity (e.g., type and pressure of the stockings, time to intervention, length of follow up), the studies showed a lower absolute frequency of PTS in patients assigned to the stockings garment arm.

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Funding: None.

Conflict of Interest: None of the authors have any financial or other potential conflicts of interest relative to the data in this manuscript.

Authorship: All authors had access to the data and a role in writing the manuscript.

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