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ARTICLE

Below-Knee Elastic Compression Stockings To Prevent the Post-Thrombotic Syndrome

A Randomized, Controlled Trial

Paolo Prandoni, MD, PhD; Anthonie W.A. Lensing, MD, PhD; Martin H. Prins, MD, PhD; Michela Frulla, MD; Antonio Marchiori, MD; Enrico Bernardi, MD, PhD; Daniela Tormene, MD; Laura Mosena, MD; Antonio Pagnan, MD; and Antonio Girolami, MD

17 August 2004 | Volume 141 Issue 4 | Pages 249-256

Background: Because only limited evidence suggests that elastic stockings prevent the post-thrombotic syndrome in patients with symptomatic deep venous thrombosis (DVT), these stockings are not widely used.

Objective: To evaluate the efficacy of compression elastic stockings for prevention of the post-thrombotic syndrome in patients with proximal DVT.

Design: Randomized, controlled clinical trial.

Setting: University hospital.

Patients: 180 consecutive patients with a first episode of symptomatic proximal DVT who received conventional anticoagulant treatment.

Interventions: Before discharge, patients were randomly assigned to wear or not wear below-knee compression elastic stockings (30 to 40 mm Hg at the ankle) for 2 years. Follow-up was performed for up to 5 years.

Measurements: The presence and severity of the post-thrombotic syndrome were scored by using a standardized scale.

Results: Post-thrombotic sequelae developed in 44 of 90 controls (severe in 10) and in 23 of 90 patients wearing elastic stockings (severe in 3). All but 1 event developed in the first 2 years. The cumulative incidence of the post-thrombotic syndrome in the control group versus the elastic stockings group was 40.0% (95% CI, 29.9% to 50.1%) versus 21.1% (CI, 12.7% to 29.5%) after 6 months, 46.7% (CI, 36.4% to 57.0%) versus 22.2% (CI, 13.8% to 30.7%) after 1 year, and 49.1% (CI, 38.7% to 59.4%) versus 24.5% (CI, 15.6% to 33.4%) after 2 years. After adjustment for baseline characteristics, the hazard ratio for the post-thrombotic syndrome in the elastic stockings group compared with controls was 0.49 (CI, 0.29 to 0.84; P = 0.011).

Limitations: This study lacked a double-blind design.

Conclusions: Post-thrombotic sequelae develop in almost half of patients with proximal DVT. Below-knee compression elastic stockings reduce this rate by approximately 50%.

Editors' Notes Context Although physicians often recommend elastic stockings to help prevent the post-thrombotic syndrome, few studies have evaluated the stockings' effectiveness. Contribution One hundred eighty patients with proximal deep venous thrombosis (DVT) were randomly assigned to wear or not wear below-knee elastic compression stockings for 2 years. More than 90% of the patients assigned to elastic stockings wore them daily during the 2-year period, but 5 of 90 patients stopped using them because of itching, redness, or discomfort. Twenty-six percent of the patients in the elastic stockings group developed the post-thrombotic syndrome compared with 49% of controls. Implications Below-knee elastic compression stockings reduce post-thrombotic sequelae in patients with proximal DVT. –The Editors

 

Author and Article Information

From University Hospital of Padua, Padua, Italy; and Academic Medical Center, Amsterdam, and Academic Hospital, Maastricht, the Netherlands.

Grant Support: By a grant from New Medical Service, Linea Flebologica Flebysan, Rovigo, Italy.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Paolo Prandoni, MD, Department of Medical and Surgical Sciences, 2nd Division of Internal Medicine, University Hospital of Padua, Via Ospedale Civile 105, 35128 Padua, Italy; e-mail, paoloprandoni{at}tin.it.

Current Author Addresses: Drs. Prandoni, Frulla, Marchiori, Bernardi, Tormene, Mosena, Pagnan, and Girolami: Department of Medical and Surgical Sciences, 2nd Division of Internal Medicine, University Hospital of Padua, Via Ospedale Civile 105, 35128 Padua, Italy.

Dr. Lensing: Center for Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.

Dr. Prins: Department of Clinical Epidemiology and Technology Assessment, Academic Hospital, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.

Author Contributions: Conception and design: P. Prandoni, A.W.A. Lensing, M. Frulla.

Analysis and interpretation of the data: M.H. Prins, A. Marchiori, E. Bernardi.

Drafting of the article: P. Prandoni, A.W.A. Lensing, M.H. Prins, E. Bernardi.

Critical revision of the article for important intellectual content: A. Pagnan, A. Girolami.

Final approval of the article: P. Prandoni, A.W.A. Lensing, M.H. Prins, M. Frulla, A. Marchiori, E. Bernardi, D. Tormene, L. Mosena, A. Pagnan, A. Girolami.

Provision of study materials or patients: P. Prandoni, M. Frulla, D. Tormene, L. Mosena.

Statistical expertise: M.H. Prins, A. Marchiori, E. Bernardi.

Obtaining of funding: P. Prandoni.

Administrative, technical, or logistic support: P. Prandoni, D. Tormene, A. Pagnan, A. Girolami.

Collection and assembly of data: P. Prandoni, M. Frulla, D. Tormene, L. Mosena.

Related articles in Annals:

Editorials
Routine Stocking Therapy after Deep Venous Thrombosis: A Clinical Dilemma
Jeffrey S. Ginsberg

Annals 2004 141: 314-315. [Full Text]  

Summaries for Patients
Can Compression Stockings Prevent the Post-Thrombotic Syndrome?

Annals 2004 141: I-12. [Full Text]  

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