Compression therapy for treating post-thrombotic syndrome of mild to moderate severity

People who have had a deep vein thrombosis (DVT) can develop post-thrombotic syndrome. This is caused by long-term clots in the affected leg and poor venous blood flow, resulting in leg pain, swelling ankles and hardened discoloured skin. The symptoms are worsened with prolonged standing or sitting and may limit lifestyle and day-to-day activities. In severe cases, venous ulcers, open sores that do not heal, also develop.

Wearing circular bandages or compression stockings after initial blood thinning (anticoagulant) treatment for DVT is used to reduce the likelihood of post-thrombotic syndrome and reduce symptoms. With severe swelling of the leg (oedema), a machine can be used to apply pressure to the leg to improve blood circulation. The review authors identified two trials investigating the effectiveness of these physical treatments for post-thrombotic syndrome. The first trial randomized 12 women and three men with a mean age of 60 years to receiving mechanical pressure using an extremity pump applying either a therapeutic 50 mm Hg pressure or low 15 mm Hg pressure twice daily for 20 minutes for one month. The participants then changed to the other pressure for a month. Twelve of the 15 participants preferred therapeutic pressure levels and nine continued to use the compression pump after the trial had finished, with small improvements in symptoms. The second trial randomly assigned 35 men and women who had experienced a DVT 12 months previously to wearing elastic compression stockings, knee or thigh high, or placebo stockings that were one to two sizes too large. Wearing correct fitting compression stockings showed no differences from placebo. After three months, 11 of 18 people wearing compression stockings failed to have improved symptoms or were still prevented from performing their daily activities for five or more days in any three month period compared with 10 of 17 wearing placebo stockings. No adverse effects were reported. The studies were too small and of too short a duration to draw strong conclusions.