Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial.
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.


METHODS
Randomized, controlled clinical trial.


METHODS
University hospital.


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


METHODS
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.


METHODS
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).


CONCLUSIONS
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%.
Prandoni
Paolo
P
Department of Medical and Surgical Sciences, University Hospital of Padua, Padua, Italy. paoloprandoni@tin.it
Lensing
Anthonie W A
AW
Prins
Martin H
MH
Frulla
Michela
M
Marchiori
Antonio
A
Bernardi
Enrico
E
Tormene
Daniela
D
Mosena
Laura
L
Pagnan
Antonio
A
Girolami
Antonio
A
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001458:Bandages / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011186:Postphlebitic Syndrome / Q000517:prevention & control*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K