Non-pharmaceutical measures for prevention of post-thrombotic syndrome

Kolbach DN, Sandbrink MWC, Hamulyak K, Prins MH, Neumann MHAM

Published Online:

October 8, 2008

People with deep vein thrombosis can significantly reduce the chance of developing post-thrombotic syndrome by wearing elastic compression stockings. Deep vein thrombosis (DVT) occurs when a blood clot blocks blood flow through a vein. People with DVT often develop chronic pain, swelling and skin changes in the legs, called post-thrombotic syndrome (PTS). Elastic compression stockings are used to try to reduce the swelling and improve blood flow in the leg veins. The review found that people with DVT who wear elastic compression stockings are less likely to develop PTS. No adverse effects have been reported, but people with a weakened arterial blood supply may experience a worsening of their condition.

Abstract (click to read)

Background:

Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic pain, swelling and skin changes in the affected limb. One in every three people with DVT will develop post-thrombotic complications within five years.

Objectives:

To determine the relative effectiveness of, and the rate of complications using, non-pharmaceutical interventions in people with DVT in the prevention of PTS.

Search strategy:

We searched the Cochrane Peripheral Vascular Diseases Group Specialised Trials register (last searched November 2005), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 4, 2005). In addition, handsearching of non-listed journals and personal communications with researchers was undertaken.

Selection criteria:

Randomised controlled trials (RCTs) of non-pharmaceutical interventions, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS. There were no restrictions on date or language. One author (DNK) identified and assessed titles and abstracts for relevance. This was verified independently by a second author (RS).

Data collection and analysis:

Data extraction was undertaken independently by two authors (DNK, RS), using data extraction sheets.

Main results:

Three RCTs that evaluated compression therapy were identified. Two studies compared elastic compression stockings with a pressure of 30-40 mm Hg at the ankle with no intervention applied directly after an episode of DVT. The other small study compared elastic compression stockings (pressure 20-30 mm Hg) with stockings that were one to two sizes too large in people one year after DVT. Overall, in the treatment group at two years, the use of elastic compression stockings was associated with a highly statistically significant reduction in the incidence of PTS with odds ratio (OR) 0.31 (95% confidence interval (CI) 0.20 to 0.48). In addition, the incidence of severe PTS was reduced from OR 0.39 (95% CI 0.20 to 0.76). In another RCT that considered the first nine days post DVT, no difference in the incidence of pulmonary embolism and size of thrombus in the femoral vein was found. A statistically significant reduction (P < 0.05) was found in pain, swelling and clinical scores, favouring the compression group.

Authors' conclusions:

There is substantial evidence that elastic compression stockings reduce the occurrence of PTS after DVT. No serious adverse effects were mentioned in the studies. Hence, elastic compression stockings should be added to the treatment of DVT to prevent the development of post-thrombotic syndrome.

This record should be cited as:

Kolbach DN, Sandbrink MWC, Hamulyak K, Prins MH, Neumann MHAM. Non-pharmaceutical measures for prevention of post-thrombotic syndrome. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004174. DOI: 10.1002/14651858.CD004174.pub2

Assessed as up to date:

August 21, 2003

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Primary Review Group:

Peripheral Vascular Diseases Group

Health topics:

Heart & circulation > Deep vein thrombosis > Post-thrombotic syndrome

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Non-pharmaceutical measures for prevention of post-thrombotic syndrome

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