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Clinician Article

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



  • Berntsen CF
  • Kristiansen A
  • Akl EA
  • Sandset PM
  • Jacobsen EM
  • Guyatt G, et al.
Am J Med. 2016 Apr;129(4):447.e1-447.e20. doi: 10.1016/j.amjmed.2015.11.031. Epub 2015 Dec 31. (Review)
PMID: 26747198
Read abstract Read evidence summary
Disciplines
  • Internal Medicine
    Relevance - 7/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Hematology
    Relevance - 6/7
    Newsworthiness - 6/7
  • Hemostasis and Thrombosis
    Relevance - 6/7
    Newsworthiness - 5/7

Abstract

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.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

As a family physician, care of patients with and after DVT is part of our role, so knowing that there is no good evidence to support the use of these stockings after DVT is important for me and I believe, for all other family physicians.

General Internal Medicine-Primary Care(US)

I have prescribed compression stockings to patients after DVTs and they have complained about how difficult it is to put them on, despite the equipment/tools available to assist with this. It may not be helping them much.

Hematology

Very interesting study. It is interesting that unblinded studies suggest effect - powerful placebo or as the author's note benefit of the "sham" stocking in the other study?

Hemostasis and Thrombosis

A meta-analysis that is dominated by a single RCT, so added value is limited.

Hemostasis and Thrombosis

Nicely done systematic review, but the results of the meta-analysis are largely driven by one RCT. This paper does not provide any "new" findings that differ from what we already knew from that 1 RCT.

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