title: Systematic Review and Meta-Analysis of Utility of Graduated Compression Stockings in Prevention of Post-Thrombotic Syndrome.
abstract: BACKGROUND
  Up to 50% of patients develop post-thrombotic syndrome (PTS) following their first proximal deep vein thrombosis (DVT). This meta-analysis aims to evaluate the effectiveness of graduated compression stockings (GCS) in preventing PTS.
  
  
  METHODS
  Medline, Embase, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were electronically searched from inception to January 2015 for studies investigating the effect of GCS in preventing PTS. All randomised control trials were considered for inclusion if they compared the efficacy of GCS (30-40 mmHg at the ankle) with either placebo or no stockings in adults with new proximal lower limb DVT. Methodological assessment, using the Cochrane Risk of Bias Tool, and data extraction was performed by two independent reviewers. The effect of GCS was expressed as the risk difference (RD).
  
  
  RESULTS
  A total of 686 articles were screened. Three randomised controlled trials inclusive of 1,177 patients were eligible for inclusion. PTS developed in 49-70% of control patients at 5 years. High statistical heterogeneity was observed between trials (all PTS: I(2) = 0.94; severe PTS: I(2) = 0.79). The risk difference in PTS incidence between control and GCS arms varied from 0% to 39% between trials. In trials with a higher baseline prevalence of PTS, a visual trend towards more benefit with GCS was noted.
  
  
  CONCLUSIONS
  Uncertainty because of sampling variability and heterogeneity was too high to conclude in favour or against an effect of wearing compression stockings in preventing PTS. An effect may be present for higher values of baseline risk. Further evidence is needed. Article history.
authors.affiliation: Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: A L
authors.initials: AL
authors.lastname: Skervin
authors.affiliation: Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Thapar
authors.affiliation: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Franchini
authors.affiliation: Department of Cardiothoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Prandoni
authors.affiliation: Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Shalhoub
authors.affiliation: Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK. Electronic address: a.h.davies@imperial.ac.uk.
authors.forename: A H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D016208:Databases, Factual; D006801:Humans; D015994:Incidence; D054070:Postthrombotic Syndrome / Q000453:epidemiology* / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D053828:Stockings, Compression; D035501:Uncertainty; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000601:surgery*
keywords: Compression stockings; Post-thrombotic syndrome; Postphlebitic syndrome; Venous thrombosis