Individually tailored duration of elastic compression therapy in relation to incidence of the postthrombotic syndrome.
OBJECTIVE
We assessed whether individualized shortened duration of elastic compression stocking (ECS) therapy after acute deep venous thrombosis (DVT) is feasible without increasing the incidence of postthrombotic syndrome (PTS).


METHODS
At the outpatient clinic of the Maastricht University Medical Centre, 125 consecutive patients with confirmed proximal DVT were followed for 2 years. Villalta scores were assessed on four consecutive visits; 3, 6, 12, and 24 months after the acute event. Reflux was assessed once by duplex testing. After 6 months, patients with scores <or=4 on the Villalta clinical score and in the absence of reflux were allowed to discontinue ECS therapy. If reflux was present, two consecutive scores <or=4 were needed to discontinue ECS therapy.


RESULTS
ECS therapy was discontinued in 17% of patients at 6 months, in 48% at 12 months, and in 50% at 24 months. Reflux on duplex testing was present in 74/101 (73.3%) tested patients and was not associated with the onset of PTS. At the 6-month visit, the cumulative incidence of PTS was 13.3%, at 12 months 17.0%, and at 24 months 21.1%. Varicosities/venous insufficiency (present at baseline) was significantly associated with PTS; hazard ratio 3.2 (1.2-9.1).


CONCLUSIONS
Patients with a low probability for developing PTS can be identified as early as 6 months after the thrombotic event, and individualized shortened duration of ECS therapy based on Villalta clinical scores may be a safe management option. These findings need to be confirmed in a randomized clinical trial.
Ten Cate-Hoek
Arina J
AJ
Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands. arina.tencate@epid.unimaas.nl
Ten Cate
Hugo
H
Tordoir
Jan
J
Hamulyák
Karly
K
Prins
Martin H
MH
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D054070:Postthrombotic Syndrome / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult
D000925:Anticoagulants