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Systematic review

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Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis.

Journal VASA. Zeitschrift für Gefässkrankheiten
Year 2016
Liens Pubmed DOI

Cet article inclut 5 Primary studies 5 Primary studies (5 references)

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BACKGROUND: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. METHODS: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. RESULTS: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. CONCLUSIONS: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.

Systematic review

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Does prescription of medical compression prevent development of post-thrombotic syndrome after proximal deep venous thrombosis?

Auteurs Perrin M , Eklöf B
Journal Phlebology / Venous Forum of the Royal Society of Medicine
Year 2016
Liens Pubmed DOI

Cet article inclut 6 Primary studies 6 Primary studies (6 references)

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Aim: The aim of this review is to try to explain the controversy by critical analysis of previously published randomized controlled trials on the value of elastic compression stockings in the treatment of acute proximal deep vein thrombosis in prevention of post-thrombotic syndrome, which forms the scientific basis for our present management. Methods: A research was made through Medline and Embase databases to identify relevant original articles, not abstracts, with the following keywords: post-thrombotic syndrome, deep venous thrombosis, venous thromboembolism, compression stockings, prevention and compliance. Results: We identified five randomized controlled trials (RCTs) before the SOX trial including 798 patients with acute proximal deep vein thrombosis. Brandjes (1997): at two years’ follow-up, elastic compression stockings reduced post-thrombotic syndrome by 50%; Ginsberg (2001): no difference in post-thrombotic syndrome with or without elastic compression stockings after more than two years’ follow-up; Partsch (2004): elastic compression stockings with routine above knee and early ambulation reduced the incidence and severity of post-thrombotic syndrome after two years’ follow-up; Prandoni (2004) showed significantly less post-thrombotic syndrome after elastic compression stockings for two years with a fiveyear follow-up; Aschwanden (2008) showed no difference with elastic compression stockings after three years’ follow-up. Conclusion: Prescription of elastic compression stockings for the prevention of post-thrombotic syndrome is now in doubt. Immediate compression after diagnosis of acute deep vein thrombosis to prevent swelling and reduce pain, permitting early ambulation in combination with adequate anticoagulation has proven benefit, although a secondary analysis of the SOX trial refutes this belief. Continued long-term compression treatment is questioned. Two major questions remain:. Is the lack of positive outcome on the development of post-thrombotic syndrome after proximal deep vein thrombosis due to the fact that there were a few patients with iliofemoral extension in the quoted randomized controlled trials who may benefit from prolonged medical compression treatment?. Compliance is the major issue, and the two randomized controlled trials with excellent control of compliance showed significant reduction in the rate of post-thrombotic syndrome, but we know that in daily practice the adherence is closer to Kahn’s data. © The Author(s) 2015.

Systematic review

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Compression Stockings for Preventing the Postthrombotic Syndrome in Patients with Deep Vein Thrombosis.

Journal The American journal of medicine
Year 2016
Liens Pubmed DOI

Cet article inclut 7 Primary studies 7 Primary studies (7 references)

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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.

Systematic review

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Compression Stockings for Prevention of Postthrombotic Syndrome: A Systematic Review and Meta-Analysis.

Auteurs Jin YW , Ye H , Li FY , Xiong XZ , Cheng NS
Journal Vascular and endovascular surgery
Year 2016
Liens Pubmed DOI

Cet article inclut 6 Primary studies 6 Primary studies (6 references)

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OBJECTIVE: The present meta-analysis aimed to evaluate the efficacy and safety of compression stockings for postthrombotic syndrome (PTS) prevention in patients with deep venous thrombosis (DVT). METHODS: Randomized controlled trials (RCTs) regarding the use of compression stockings for prevention of PTS were identified from the Medline, PubMed, and Embase databases as well as the Cochrane library. The resulting manuscripts were analyzed according to the criteria in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Six RCTs involving 1465 patients with DVT were included. The meta-analysis indicated no statistical differences between the compression stocking and the control groups in PTS incidence, using either the Villalta scale (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.23-1.74) or the Ginsberg scale (OR, 1.13; 95% CI, 0.72-1.77). Based on the Villalta scale categorization, there were no differences in the incidence of mild-moderate PTS (OR, 0.71; 95% CI, 0.36-1.41) or incidence of severe PTS (OR, 0.68; 95% CI, 0.15-3.11). The difference in the recurrence of venous thromboembolism (OR, 0.89; 95% CI, 0.61-1.30) was also not significant. In the 3 RCTs that reported side effects of compression stockings, they were primarily related to discomfort, including itching, erythema, and rash. CONCLUSION: The present meta-analysis has indicated that compression stockings may not prevent PTS, as determined by either the Villalta or the Ginsberg scale, in patients with DVT. However, owing to the limited number of trials, the evidence is not strong enough to draw a reliable conclusion. Further larger, randomized, double-blind, placebo-controlled, multicenter trials are needed.

Systematic review

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COMPRESSION STOCKINGS USE TO PREVENT POST THROMBOTIC SYNDROME IN DVT PATIENTS: A META-ANALYSIS OF RANDOMIZED CONTROL STUDIES

Journal Journal of the American College of Cardiology
Year 2015
Liens DOI

Cet article inclut 6 Primary studies 6 Primary studies (6 references)

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Systematic review

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Compression Therapy in the Prevention of Postthrombotic Syndrome: A Systematic Review and Meta-Analysis.

Auteurs Tie HT , Luo MZ , Luo MJ , Li K , Li Q , Wu QC
Journal Medicine
Year 2015
Liens Pubmed DOI PubMed Central

Cet article inclut 10 Primary studies 9 Primary studies (10 references)

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Although compression therapy has been widely used after deep vein thrombosis (DVT), its efficacy in prevention of postthrombotic syndrome (PTS) remains disputable. We aimed to update the meta-analysis to comprehensively evaluate the effect of compression therapy on the prevention of PTS in adult patients after DVT.PubMed, Embase, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) evaluating the preventive effect of compression therapy on PTS in adult patients after DVT were included. The primary outcome was the incidence of PTS. All meta-analyses were performed using random-effects models regardless of the heterogeneity. Subgroup and sensitivity analysis were also performed to examine the robustness of the pooled effects according to our predesigned plan. Potential publication bias was assessed.Eight RCTs with 1598 patients were included. Overall, compression therapy could significantly reduce the incidence of PTS (estimate 0.68, 95% confidence interval [CI] 0.52-0.90; P = 0.007). However, it was only associated with a reduction in the incidence of mild/moderate PTS (relative risk [RR] 0.66, 95% CI 0.46-0.93; P = 0.019) but not in the incidence of severe PTS (RR 0.64, 95% CI 0.27-1.50; P = 0.31). Additionally, compression therapy failed to reduce the incidence of recurrent venous thromboembolism (RR 0.91, 95% CI 0.65-1.27; P = 0.58), the incidence of ulceration (RR 0.74, 95% CI 0.36-1.53; P = 0.42), or mortality (RR 0.99, 95% CI 0.72-1.37; P = 0.96). No publication bias was observed.Current evidence still supports compression therapy to be a clinical practice for prophylaxis of PTS in adult patients after DVT. However, our findings should be cautiously interpreted because of heterogeneity and hence more large-scale and well-designed RCTs are still warranted.

Systematic review

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La compression veineuse pour la prévention du syndrome post-thrombotique: une méta-analyse.

automatic
Journal The American journal of medicine
Year 2010
Liens Pubmed DOI

Cet article est inclus dans 1 Structured summary of systematic reviews 5 Structured summaries of systematic reviews (1 reference)

Cet article inclut 5 Primary studies 5 Primary studies (5 references)

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OBJECTIF: Déterminer l'efficacité des bas de compression veineuse ou de bandages de compression sur la réduction du syndrome post-thrombotique chez les patients présentant une thrombose veineuse profonde. MÉTHODES: Nous avons tenté d'identifier tous les essais publiés dans toutes les langues identifiées par PubMed à Juin 2009. La méta-analyse a été effectuée. RÉSULTATS: Sur la base de 5 essais randomisés de patients atteints de thrombose veineuse profonde comparant le traitement par compression veineuse à des contrôles, d'intensité légère à modérée syndrome post-thrombotique s'est produite dans 64 des 296 (22%) traités avec la compression veineuse, comparativement à 106 de 284 (37% ) chez les témoins (risque relatif = 0,52). Syndrome post-thrombotique sévère a eu lieu dans 14 des 296 (5%) traités, comparativement à 33 sur 284 (12%) des contrôles (risque relatif = 0,38). Tout syndrome post-thrombotique s'est produite dans 89 des 338 (26%) traités, comparativement à 150 de 324 (46%) des contrôles (risque relatif = 0,54). CONCLUSION: la compression veineuse a réduit l'incidence du syndrome post-thrombotique, en particulier le syndrome post-thrombotique. De compression veineuse chez les patients présentant une thrombose veineuse profonde semble être indiqué à cet effet. Il y avait, cependant, de grandes variations dans le type de bas utilisé, l'intervalle de temps entre le diagnostic et à l'application des bas, et la durée du traitement. Une enquête plus poussée, par conséquent, est nécessaire.