Do Compression Stockings Prevent Postthrombotic Syndrome? – “No”

Stephan Moll, MD writes…  A new publication in the Lancet [ref 1] shows that elastic compression stockings after a first episode of proximal DVT do NOT prevent postthrombotic syndrome (PTS) as assessed over 2 years.  This is a good-quality,  large, randomized placebo-controlled trial, called the SOX-trial.

The SOX Trial

Background

Two previous studies showed that wearing elastic compression stockings did decrease the risk of developing PTS [ref 2,3].  However, the limitation of the study has been their small size, the fact that they were single-center trials, and that they were not placebo-controlled.  Based on these 2 studies until now compression stockings (30/40 mm Hg) have been suggested for patients with DVT to prevent PTS [ref 4].

Methods

This was a multicenter, randomized, placebo-controlled trial in patients with acute first episode of proximal DVT.  Patients wore either 30-40 mm Hg graduated elastic compressions stockings or “placebo stockings” with identical appearance but less than 5 mm Hg compression at the ankle.  The follow-up period was 2 years.

Results

• 806 patients were enrolled: 410 received elastic compression stockings, 396 placebo stockings.
• PTS (as assessed by the so-called “Ginsberg’s criteria”) developed in 14.2 % in the active stocking group, and in 12.7 % in the placebo stocking group (hazard ratio 1.13, 95% CI 0.73-1.76; p=0.58).
• By the so-called Villalta score (a different PTS scoring system) there was also no difference in PTS development between the 2 groups: 7.5 % and 5,8 % developed severe PTS in the active stocking group and the placebo stocking group, respectively; 8.3 % and 10. 5 moderate PTS; 33 % and 32.1 % mild PTS; and 51.3 % and 51.4 % no PTS.

Conclusion

Elastic compression stockings did not prevent PTS after a first proximal DVT.

 

Clinical Relevance

This is a very interesting and relevant study. Compression stockings used to be fairly strongly recommended by many physicians, in the belief that they would prevent postthrombotic syndrome.  We now have evidence from a large and well-done trial that they do NOT prevent PTS.  Therefore, the discussion with the patient now is that he/she can wear stockings if he/she feels that they make the leg feel better – less pain, less swelling while being worn.  However, I now discuss with my patients that the stockings do NOT have a lasting beneficial effect – thus, if they do not make the leg feel better or if they are actually uncomfortable to wear, then there is no reason to wear them.

References

1. Kahn SR et al. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet, published online Dec 6, 2013.
2. Brandjes DPM et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349: 759–62.
3. Prandoni P, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004; 141: 249–56.
4. Kearon C et al. Antithrombotic Therapy for VTE – Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2_suppl):e419S-e494S.

 

Disclosures: I have no financial conflict of interest.

Last updated:  Dec 18th, 2013