Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial

Kahn, Susan R.; Shapiro, Stan; Wells, Philip S.; Rodger, Marc; Kovacs, Michael J.; Anderson, David R.; Tagalakis, Vicky; Houweling, Adrielle H; Ducruet, Thiérry; Holcroft, Christina; Johri, Mira; Solymoss, Susan; Miron, Marie‐José; Yeo, Erik; Smith, Rebecca; Schulman, Sam; Kassis, Jeannine; Kearon, Clive; Chagnon, Isabelle; Wong, Turnly; Demers, Christine; Hanmiah, Rajendar; Kaatz, Scott; Selby, Rita; Rathbun, Suman; Desmarais, Sylvie; Opatrny, Lucie; Ortel, Thomas L.; Ginsberg, Jeffrey S.

doi:10.1016/s0140-6736(13)61902-9

Cited by 458 publications

(367 citation statements)

References 32 publications

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“…Another RCT [21] had to be excluded because attempts to access data from the authors were not successful. Table I presents the study and patient characteristics of all RCTs included in this systematic review (detailed infor- [22]; the other trial results were from between 1997 and 2008. In four RCTs, the study personnel were blinded [14,[22][23][24], and in one RCT neither the patients nor the study personnel were blinded [25].…”

Section: Study Selectionmentioning

confidence: 99%

“…In three RCTs [14,22,23], patients started to wear compression stockings, placebo stockings [22] or no stockings [14,23] within the fi rst 5 to 21 days after diagnosis of DVT. In one trial [25], all patients wore compression stockings for the fi rst six months after the diagnosis of DVT and patients without PTS six months after diagnosis of DVT were randomized.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In the study by Ginsberg et al [24], patients started to wear stockings or placebo stockings after one year without PTS after fi rst diagnosis of DVT. Two RCTs compared compression stockings to placebo stockings [22,24] and three RCTs compared compression stockings to no stockings [14,23,25]. The pressure of the applied stockings varied between 20 and 40 mmHg.…”

Section: Study Characteristicsmentioning

confidence: 99%

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

Burgstaller

Steurer

Held

et al. 2016

Vasa

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Summary:Background: Here, we update an earlier systematic review on the preventive effi cacy 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 effi cacy 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 fi rst three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically signifi cant 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 signifi cant reduction in symptoms, whereas another RCT failed to show any benefi t of using compression stockings. Conclusions: At this time, it does not seem to be justifi able 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 benefi t of compression stockings.

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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

Burgstaller

Steurer

Held

et al. 2016

Vasa

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“…In a systematic review of fi ve randomized trials in patients treated for DVT, LMWH (treatment duration for a minimum of three months) was associated with signifi cant increase in venous re-canalization (relative risk ratio 0.66; 95 % CI, 0.57 -0.77) and decrease in venous ulceration when compared with warfarin [7]. A recently published large randomized controlled trial showed no benefi t of graduated compression stockings for the prevention of PTS [8].Infl ammatory biomarkers such as interleukin-6, C-reactive protein (CRP), and intercellular adhesion molecule-1 may be used to predict the development of PTS [1]. In a recent cohort study, cHDL levels < 35 mg/dL and cLDL levels > than 180 mg/dL were risk factors for the development of recurrent thrombosis and PTS [9].…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Statins for the prevention of post-thrombotic syndrome in patients with deep vein thrombosis Comment on San Norberto et al, p. 133 - 140

Stevenson

Gándara

2016

Vasa

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83Post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT) [1]. With a wide variety of presentations ranging from minor leg swelling to severe complications, such venous stasis ulcers, PTS can signifi cantly decrease quality of life [2]. Patients who have extensive DVT, recurrent ipsilateral thrombosis, a history of varicose veins, obesity, or residual thrombus are at an increased risk of developing PTS [1].The best therapeutic approach for the prevention of PTS remains a matter of debate [3,4]. Maintaining a therapeutic international normalized ratio (INR) with warfarin has been associated with lower chances of developing PTS. In patients with extensive DVT, randomized controlled trials have shown that the use of catheter directed lysis reduces the incidence of PTS [5,6]. Other research has suggested that extended treatment with low molecular weight heparin (LMWH) signifi cantly reduces the incidence of PTS and ulcers. In a systematic review of fi ve randomized trials in patients treated for DVT, LMWH (treatment duration for a minimum of three months) was associated with signifi cant increase in venous re-canalization (relative risk ratio 0.66; 95 % CI, 0.57 -0.77) and decrease in venous ulceration when compared with warfarin [7]. A recently published large randomized controlled trial showed no benefi t of graduated compression stockings for the prevention of PTS [8].Infl ammatory biomarkers such as interleukin-6, C-reactive protein (CRP), and intercellular adhesion molecule-1 may be used to predict the development of PTS [1]. In a recent cohort study, cHDL levels < 35 mg/dL and cLDL levels > than 180 mg/dL were risk factors for the development of recurrent thrombosis and PTS [9].In addition to a reduction in cholesterol and high-sensitivity CRP, current data suggests that statin therapy aff ects the coagulation cascade by inhibiting the activity of tissue factor and platelet activation by reducing the expression of circulating molecules, such as soluble CD40L or P-selectin [10]. In recent randomized controlled trials and metaanalysis, it has been suggested that statins reduce the incidence of fi rst occurrence venous thromboembolism [11,12]. Interestingly, statin therapy did not reduce the incidence of recurrent VTE in patients being treated for acute DVT or pulmonary embolism with oral anticoagulation [13].To date clinicians and researchers are still unclear as to whether or not statins can reduce the incidence of PTS. Recent data from animal models of VTE has suggested that statin therapy reduced the incidence of deep vein thrombosis induced vein wall scarring by 50 % [14]. In this issue of VASA-European Journal of Vascular Medicine, San Norberto and colleagues present the fi rst trial evaluating the use of statin therapy (rosuvastatin 10 mg (or 5 mg for patients > 70 years) for the prevention of PTS in patients treated for DVT [15]. In this trial, patients diagnosed with DVT were treated with three months of LMWH therapy and were randomized to receive rosuvastat...

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Treatment of Venous Thromboembolism

Wells

Forgie

Rodger

2014

JAMA

196

134

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The mainstay of VTE treatment is anticoagulation, while interventions such as thrombolysis and inferior vena cava filters are reserved for limited circumstances. Multiple therapeutic modes and options exist for VTE treatment with small but nonetheless important differential effects to consider. Anticoagulants will probably always increase bleeding risk, necessitating tailored treatment strategies that must incorporate etiology, risk, benefit, cost, and patient preference. Although great progress has been made, further study to understand individual patient risks is needed to make ideal treatment decisions.

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Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial

Cited by 458 publications

References 32 publications

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

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

Statins for the prevention of post-thrombotic syndrome in patients with deep vein thrombosis Comment on San Norberto et al, p. 133 - 140

Treatment of Venous Thromboembolism

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