Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial

Abstract

Postthrombotic syndrome (PTS) is a burdensome and costly complication of deep vein thrombosis (DVT) that develops in 20%‐40% of patients within 2 years after proximal DVT. In the absence of effective curative treatment, management of PTS relies on its prevention after DVT. The effectiveness of elastic compression stockings (ECS) to prevent PTS is uncertain. We present an overview of published studies assessing the efficacy of ECS to prevent PTS and present the protocol for the CELEST clinical trial. While previous open‐label randomized trials have reported a 50% risk reduction in PTS in patients treated with >30 mm Hg ankle pressure ECS, a large double‐blind trial reported no effect of ECS. We discuss the main potential limitations of these trials, including a placebo effect and suboptimal compliance to ECS. We present the protocol of the CELEST double‐blind randomized trial comparing 2 years of high strength (ankle pressure 35 mm Hg) versus lower strength (ankle pressure 25 mm Hg) ECS in the prevention of PTS after a first acute symptomatic, unilateral, proximal DVT. The use of lower‐strength ECS than that used in previous studies should favor compliance. CELEST may provide important evidence about the efficacy of ECS in the prevention of PTS after DVT. The results will be interpreted in the light of results from recent clinical trials assessing ECS for PTS prevention that reported that the duration of ECS use should be tailored to the individual, if ECS are efficacious in the prevention of PTS.

The Efficacy of Compression Stockings on Patients With Nocturia: A Single-Arm Pilot Study

“…In the present study, compression stockings with a pressure range between 15 and 20 mmHg were used. The effective pressure of compression stockings varies by the product and with the disease -between 25 and 35 mmHg for deep vein thrombosis and between 18 and 35 mmHg for venous ulceration [16,17]. Further studies are warranted to examine whether the pressure of compression stockings exerts different effects on nocturia.…”

MUFFIN-PTS trial, Micronized Purified Flavonoid Fraction for the Treatment of Post-Thrombotic Syndrome: protocol of a randomised controlled trial

“…47 48 Regarding study design, given the high risk of a placebo effect in PTS studies, we opted for a doubleblind design. 49 Our sample size could be perceived as Open access modest. However, based on our careful literature review, we hypothesise that there will be a 50% improvement in the primary study outcome in the MPFF arm, compared with placebo.…”

Characteristics and Treatment Strategy of Isolated Calf Deep Venous Thrombosis after Fractures: A Review of Recent Literature

“…Among 96 patients who wore ECS, 30 (31%) developed PTS after 2 years of follow-up, while the incidence of PTS in patients without ECS was as high as 70%. Recent studies [61][62][63] have shown relatively consistent results in that wearing compression stockings providing a pressure of 30-40 mmHg after a diagnosis of thrombosis could halve the incidence of PTS after 2 years (from approximately 50.0% to 24.5%). However, a recent 64 randomized placebo-controlled trial involving 806 patients with DVT at 24 centers in the United States and Canada yielded opposite results.…”