Concept: Compression stockings
Whether compression stockings are effective in the prevention of post thrombotic syndrome in patients with deep vein thrombosis remains unknown. Since the recently published SOX trial, no meta-analysis has been done to re-evaluate the available literature on whether compression stockings are beneficial in these patients. We aimed to determine the effectiveness of elastic compression stockings on preventing post thrombotic syndrome in patients with deep vein thrombosis.
To study whether stopping elastic compression stockings (ECS) after 12 months is non-inferior to continuing them for 24 months after proximal deep venous thrombosis.
Post-thrombotic syndrome (PTS) is a common and burdensome complication of deep venous thrombosis (DVT). Previous trials suggesting benefit of elastic compression stockings (ECS) to prevent PTS were small, single-centre studies without placebo control. We aimed to assess the efficacy of ECS, compared with placebo stockings, for the prevention of PTS.
Therapy with elastic compression stockings has been the cornerstone for prevention of post-thrombotic syndrome for decades in patients after acute deep venous thrombosis. It is uncertain who benefits most from therapy, and what the optimum duration of therapy should be. We therefore aimed to assess the safety and efficacy of individualised duration of compression therapy versus the standard duration of 24 months following an initial treatment period of 6 months.
Current standard therapy for patients with acute proximal deep vein thrombosis (DVT) consists of anticoagulant therapy and graduated elastic compression stockings. Despite use of this strategy, the postthrombotic syndrome (PTS) develops frequently, causes substantial patient disability, and impairs quality of life. Pharmacomechanical catheter-directed thrombolysis (PCDT), which rapidly removes acute venous thrombus, may reduce the frequency of PTS. However, this hypothesis has not been tested in a large multicenter randomized trial.
The post-thrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that imposes significant morbidity, reduces quality of life and is costly. After DVT, 20-50% of patients will develop PTS, and up to 5% will develop severe PTS. The principal risk factors for PTS are anatomically extensive DVT, recurrent ipsilateral DVT, obesity and older age. By preventing the initial DVT and DVT recurrence, primary and secondary prophylaxis of DVT will reduce the occurrence of PTS. The effectiveness of elastic compression stockings (ECS) for PTS prevention is controversial. Catheter-directed thrombolysis is not effective to prevent PTS overall, but may prevent more severe forms of PTS, and should be reserved for select patients with extensive thrombosis, recent symptoms onset, and low bleeding risk. For patients with established PTS, the cornerstone of management is ECS, exercise and lifestyle modifications. Surgical or endovascular interventions may be considered in refractory cases. Due to a lack of effective therapies, new approaches to preventing and treating PTS are needed.
: Institutional protocols need to address the indications for pharmacological and mechanical thromboprophylaxis. The use of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) strongly differs between institutions. As a consequence, no strong recommendations can be made based on the contemporary high-level evidence. Although different clinical practices can be supported, such approaches should be part of an institutional strategy to reduce the burden of venous thromboembolism (VTE). We recommend against the use of GCS alone without pharmacological thromboprophylaxis for prevention of VTE in patients at intermediate and high risk. For patients at high risk of VTE with contraindications for pharmacological thromboprophylaxis, we recommend the use of mechanical prophylaxis and suggest the use of IPC over GCS. However, for those patients receiving pharmacological thromboprophylaxis who are without a very high risk of VTE prophylaxis, we recommend against the routine use of mechanical thromboprophylaxis either with GCS or IPC. We suggest combined mechanical and pharmacological prophylaxis in selected patients at very high risk of VTE prophylaxis and suggest IPC rather than GCS in these selected patients.
Effect of graduated compression stockings on venous lower limb hemodynamics in healthy amateur runners
- Journal of vascular surgery. Venous and lymphatic disorders
- Published over 2 years ago
The objective of this study was to analyze the effect of graduated compression stockings (GCS) on venous lower limb hemodynamics in healthy amateur runners.
To investigate the effectiveness of graduated elastic compression stockings (GECS) below the knee in improving symptoms in patients with varicose veins in the absence of high quality evidence.
- Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
- Published over 2 years ago
Despite the popularity of sclerotherapy for treating varicose veins, it still exhibits various problems, such as pulmonary embolism, deep-vein thrombosis, phlebitis, and visual disorders.