title: Compression Stockings for Preventing the Postthrombotic Syndrome in Patients with Deep Vein Thrombosis.
abstract: OBJECTIVE
  We conducted a systematic review and meta-analysis to address benefits and harms of using elastic compression stockings after lower-extremity deep vein thrombosis.
  
  
  METHODS
  We searched 7 electronic databases through January 15, 2015, including randomized controlled trials (RCTs)/quasi-randomized trials reporting on elastic compression stocking efficacy on postthrombotic syndrome incidence, recurrent venous thromboembolism, mortality, and acute pain after deep vein thrombosis. Two reviewers independently screened records, extracted data, assessed risk of bias, and assessed confidence in effect estimates using Grading of Recommendations Assessment, Development, and Evaluation methodology. We applied random-effects meta-analysis models.
  
  
  RESULTS
  We included 5 RCTs (n = 1418) reporting on postthrombotic syndrome. The hazard ratio (HR) for postthrombotic syndrome with elastic compression stockings was 0.69 (95% confidence interval [CI], 0.47-1.02). We have very low confidence in this estimate due to heterogeneity and inclusion of unblinded studies at high risk of bias. Excluding high risk of bias studies, a single large RCT at low risk of bias provided moderate-quality evidence of no effect on postthrombotic syndrome (HR 1.00; 95% CI, 0.81-1.24). Moderate-quality evidence including all 5 studies suggests no effect of elastic compression stockings on recurrent venous thromboembolism (relative risk [RR] 0.88; 95% CI, 0.63-1.24) or mortality (RR 1.00; 95% CI, 0.73-1.37, 5 studies). Moderate-quality evidence from one large RCT does not suggest effect on acute pain after deep vein thrombosis.
  
  
  CONCLUSIONS
  The highest-quality evidence available suggests no effect of elastic compression stockings on postthrombotic syndrome or pain relief, from a single large RCT. However, results for preventing postthrombotic syndrome differ substantially across studies, and future guideline updates should reflect uncertainty about treatment effects. Elastic compression stockings are unlikely to prevent death or recurrent venous thromboembolism.
authors.affiliation: Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway. Electronic address: christfb@gmail.com.
authors.forename: Christopher Friis
authors.initials: CF
authors.lastname: Berntsen
authors.affiliation: Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Annette
authors.initials: A
authors.lastname: Kristiansen
authors.affiliation: Department of Internal Medicine, American University of Beirut, Lebanon.
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: Department of Haematology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Per Morten
authors.initials: PM
authors.lastname: Sandset
authors.affiliation: Department of Haematology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Eva-Marie
authors.initials: EM
authors.lastname: Jacobsen
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Per Olav
authors.initials: PO
authors.lastname: Vandvik
mesh_terms: D006801:Humans; D054070:Postthrombotic Syndrome / Q000517:prevention & control*; D012008:Recurrence; D053828:Stockings, Compression; D054556:Venous Thromboembolism / Q000401:mortality / Q000517:prevention & control
keywords: Compression stockings; Deep vein thrombosis; Meta-analysis; Postthrombotic syndrome