title: Prevention and treatment of postphlebitic syndrome: results of a 3-part study.
abstract: BACKGROUND
  The true incidence of postphlebitic syndrome (PPS) following proximal deep venous thrombosis (DVT) and the efficacy of graduated compression stockings in preventing and treating PPS are unknown.
  
  
  METHODS
  A 3-part study of 202 patients evaluated 1 year after proximal DVT: 2 randomized placebo-controlled trials of stockings and 1 prospective cohort of untreated patients. Patients were evaluated for PPS, using a standardized questionnaire, and for venous valvular incompetence, using photoplethysmography and venous Doppler. They were enrolled in study 1 or study 2 if they did not have symptomatic PPS and did not have or had venous valvular incompetence, respectively, and into study 3 if they had symptomatic PPS. Study 1 patients were left untreated and followed up for development of PPS every 6 months for a mean of 55 months. Study 2 patients were randomized to a below-knee stocking (20-30 mm Hg) or a matched placebo stocking, and followed up for development of PPS every 6 months for a mean of 57 months. Study 3 patients were randomized to an active stocking (30-40 mm Hg) or a matched placebo stocking and followed up every 3 months for treatment failure, defined a priori.
  
  
  RESULTS
  In study 1, 6 (5.0%) of 120 patients were categorized as treatment failures, a rate similar to placebo-treated study 2 patients (P =.10). In study 2, 0 (0%) of 24 active and 1 (4.3%) of 23 placebo-treated patients were categorized as treatment failures (P =.49). In study 3, 11 (61.1%) of 18 active and 10 (58.8%) of 17 placebo-treated patients were categorized as treatment failures (P>.99).
  
  
  CONCLUSIONS
  Most patients do not have PPS 1 year after proximal DVT, and do not require stockings. We failed to show a benefit of stockings in patients with PPS, but the small numbers preclude definitive conclusions.
authors.affiliation: Department of Medicine, McMaster University Medical Center, 1200 Main St W, HSC-3W11, Hamilton, Ontario, Canada L8N 3Z5.
authors.forename: J S
authors.initials: JS
authors.lastname: Ginsberg
authors.forename: J
authors.initials: J
authors.lastname: Hirsh
authors.forename: J
authors.initials: J
authors.lastname: Julian
authors.forename: M
authors.initials: M
authors.lastname: Vander LaandeVries
authors.forename: D
authors.initials: D
authors.lastname: Magier
authors.forename: B
authors.initials: B
authors.lastname: MacKinnon
authors.forename: M
authors.initials: M
authors.lastname: Gent
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011186:Postphlebitic Syndrome / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000628:therapy*