Venous Thromboembolism - Compression stockings reduced post-thrombotic syndrome

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Venous Thromboembolism - Compression stockings reduced post-thrombotic syndrome

Clinical Bottom Line:

Compression stockings reduced the occurrence of the post-thrombotic syndrome in proximal DVT.

Citation: Brandjes DP, Buller HR, Heijboer H et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997;349:759-62.

Clinical Question: In patients with proximal DVT, would the addition of compression stockings to an appropriate anticoagulation regimen reduce the frequency and severity of post-thrombotic syndrome?

Search Terms: "venous thromboembolism" and "compression stockings" in MEDLINE

The Study:

Unblinded RCT with intention-to-treat analysis.

Consecutive patients with venographically proven proximal DVT.

Control group (N = 98; 98 analysed): anticoagulation for 3 months

Experimental group (N = 96; 96 analysed): anticoagulation for 3 months plus sized-to-fit graded elastic compression stockings

The Evidence:

Outcome	Time to Outcome	CER	EER	RRR	ARR	NNT
mild to moderate post-thrombotic syndrome	median 76 months	0.47	0.20	57%	0.27	4
95% Confidence Intervals:				30% to 85%	0.143 to 0.397	3 to 7
severe post-thrombotic syndrome	median 76 months	0.23	0.11	52%	0.120	8
95% Confidence Intervals:				7% to 97%	0.016 to 0.224	4 to 63

Comments:

Post-thrombotic syndrome was defined by a scoring system that included pain (at rest or walking), swelling, varicosities, pigmentation, ulceration, and impairment of daily activities.
76% of patients always wore their stockings and only 7% seldom or never did
31% of patients in stocking group still developed post-thrombotic syndrome

Appraised by: Straus ; 20 November 1997;

Expiry date: December 1998;

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