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DVT Post-thrombotic Syndrome Reduced by 50%
Henry I. Bussey, Pharm.D.
Review: Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome. Annals of Internal Medicine 2004; 141:249-256.
The use of "off-the-shelf", below the knee compression stockings that provided 30 to 40 mm Hg pressure at the ankle was shown in a prospective, randomized trial to reduce the incidence of post-thrombotic syndrome by almost 50% at 2 years of follow-up. 180 patients with an initial, unilateral, symptomatic proximal deep vein thrombosis (DVT) were randomized before hospital discharge (5 to 10 days after admission) either to wear or not wear elastic compression stockings. Patients assigned to wear a stocking were given 2 stockings and these were replaced every six months. Stockings were to be used during the day (or longer) for 2 years. Patients were followed for a total period of 3 to 5 years. The post-thrombotic syndrome occurred in 44 of 90 patients not assigned to wear stockings and in 23 of 90 assigned to wear stockings. The syndrome was severe in 10 and 3 cases (no stockings vs. stocking wearing group, respectively). Importantly, the majority of cases of post-thrombotic syndrome occurred within the first six months and only one case developed after 2 years. The calculated number needed to treat to prevent one case of post thrombotic syndrome is 4.3 patients.
Interestingly, only 3 patients were lost to follow up during the study, and getting patients to wear the stockings was not a significant problem. Of the 90 patients, only 6 discontinued stocking use (5 because of intolerance and one because of difficulty putting on the stocking). Of the remaining 84 patients, 78 wore the stocking at least 80% of daytime hours.
The incidence of symptomatic, confirmed recurrent venous thrombosis events (VTE) was not different between the two groups (13.3% and 14.4% in the stocking and no stocking groups, respectively). Of 25 recurrent VTEs, 18 were DVT (7 ipsilateral and 11 contralateral) and 7 were pulmonary emboli (3 fatal). The only 2 risk factors that were significantly associated with an increased risk of post thrombotic syndrome were age (hazard ratio of 1.6 for every 10 year increase in age) and ipsilateral DVT recurrence (hazard ratio of 3.3 which is less than a hazard ratio of approximately 6 reported in an earlier study by the same author).
The benefits of off-the shelf, below the knee compression stockings reported in this well-done trial are similar to the results previously reported for more expensive and difficult to obtain tailor-made, size-to-fit elastic compression stockings.
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