SR Kahn
Lancet 2013 Dec 06;[EPub Ahead of Print]

TAKE-HOME MESSAGE

• In this prospective study comparing the use of graduated elastic compression stockings vs no use after first proximal DVT, compression stockings did not reduce the incidence of post-thrombotic syndrome at 2 years. In addition, no improvement in venous ulcers, DVT recurrence, venous valvular reflux at 12 months, or quality of life was reported.
• Results were similar across subgroups.

ABSTRACT

BACKGROUND

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.

METHODS

We did a multicentre randomised placebo-controlled trial of active versus placebo ECS used for 2 years to prevent PTS after a first proximal DVT in centres in Canada and the USA. Patients were randomly assigned to study groups with a web-based randomisation system. Patients presenting with a first symptomatic, proximal DVT were potentially eligible to participate. They were excluded if the use of compression stockings was contraindicated, they had an expected lifespan of less than 6 months, geographical inaccessibility precluded return for follow-up visits, they were unable to apply stockings, or they received thrombolytic therapy for the initial treatment of acute DVT. The primary outcome was PTS diagnosed at 6 months or later using Ginsberg’s criteria (leg pain and swelling of ≥1 month duration). We used a modified intention to treat Cox regression analysis, supplemented by a prespecified per-protocol analysis of patients who reported frequent use of their allocated treatment.

FINDINGS

From 2004 to 2010, 410 patients were randomly assigned to receive active ECS and 396 placebo ECS. The cumulative incidence of PTS was 14·2% in active ECS versus 12·7% in placebo ECS (hazard ratio adjusted for centre 1·13, 95% CI 0·73—1·76; p=0·58). Results were similar in a prespecified per-protocol analysis of patients who reported frequent use of stockings.

INTERPRETATION

ECS did not prevent PTS after a first proximal DVT, hence our findings do not support routine wearing of ECS after DVT

Full Story:  http://www.practiceupdate.com/journalscan/7136
Journal Reference:  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961902-9/abstract