Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome

Abstract

Objective The purpose of this randomized study was to evaluate the influence of immediate multilayer compression bandages before application of elastic stockings in the acute phase of deep-vein thrombosis (DVT) on development of the post-thrombotic syndrome (PTS). Methods Sixty-nine patients with acute symptomatic DVT were randomized to immediate bandaging (n = 34) or no bandaging (n = 35). After reduction of edema sized-to-fit elastic stockings were applied in all patients after 7-14 days. Follow-up visits and non-invasive examinations were planned after 7, 30 and 90 days and 1 year. Venous outflow resistance (VOR) was measured by strain gauge plethysmography. Thrombosis score (TS) and reflux were measured by duplex scanning. After one year patients were evaluated for clinical PTS using both the clinical scale of the CEAP classification and the Villalta score. Results Improvement of clinical symptoms and decrease of leg circumference was better on day 7 in the bandaging group, but after 1 and 3 months clinical symptoms had improved equally in both groups. In 7 patients in the no-bandaging group a bandage was applied after all because of persistent edema after 10 days. There were no differences in VOR, TS and reflux. Using the CEAP classification the incidence of PTS was 39% in patients with bandages and 42% in patients without bandages (RR 0.91,. Using the Villalta score the incidence of PTS was resp. 29 and 33% (RR 0.87, 95% CI 0.41-1.8). There was no difference in severity of PTS. Conclusion Immediate multilayer compression bandaging in the acute phase of DVT is effective in reducing edema and complaints in the first week, but has no effect on thrombus regression, valve incompetence and the development of clinical PTS after 1 year.

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…519 Multilayer compression is effective only for symptoms and not for development of PTS. 520 The duration of compression for efficacy has not been rigorously determined by prospective studies. 521 However, per the current American College of Chest Physicians 2012 guidelines, use of compression stockings immediately after diagnosis of DVT and continued compression for at least 6 months to 2 years are supported.…”

Rationale and design of the ATTRACT Study: A multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis

“…We do not initiate compression therapy earlier because leg swelling can decrease markedly during the first 10 days which makes it difficult to fit the stockings. In addition, some patients’ legs are very tender initially, and published studies differ on whether very early compression influences the risk of developing PTS (14). A new pair of stockings is provided every 6 months.…”

Timing and duration of compression therapy after deep vein thrombosis

“…Yet, the effect of early compression on the long term development of PTS is still unclear as studies performed so far have conflicting outcomes. [16][17][18][19] The studies performed all had limited sample sizes and used different definitions for PTS; therefore a sufficiently large study is needed to assess the effect of early compression on PTS development in order to provide us with a definitive answer. Besides the clear benefits for the patient's wellbeing such as reduction of pain and edema, it may be prudent to start ECS therapy, with its perceived benefit of restoring the venous ejection fraction and counteracting the exudation of venous fluids, as soon as possible after the DVT.…”

“…In addition, there were no significant differences in venous outflow resistance, thrombosis score, or reflux between the two groups. 19 …”