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Thromb Haemost 2006; 96(04): 441-445
DOI: 10.1160/TH06-05-0258
Review Article
Schattauer GmbH

Review on the value of graduated elastic compression stockings after deep vein thrombosis

Stavros K. Kakkos
1   Vascular Unit, Ealing Hospital and Department of Vascular Surgery, Imperial College London, London, UK
,
Stella S. Daskalopoulou
1   Vascular Unit, Ealing Hospital and Department of Vascular Surgery, Imperial College London, London, UK
,
Marios E. Daskalopoulos
1   Vascular Unit, Ealing Hospital and Department of Vascular Surgery, Imperial College London, London, UK
,
Andrew N. Nicolaides
1   Vascular Unit, Ealing Hospital and Department of Vascular Surgery, Imperial College London, London, UK
,
George Geroulakos
1   Vascular Unit, Ealing Hospital and Department of Vascular Surgery, Imperial College London, London, UK
› Author Affiliations
Further Information

Publication History

Received 12 May 2006

Accepted after resubmission 28 August 2006

Publication Date:
29 November 2017 (online)

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Summary

Graduated elastic compression stockings (GECS) are commonly used in the primary prevention of deep vein thrombosis (DVT); however, their role in preventing recurrent DVT and also post-thrombotic syndrome is less well established. The aim of this review was to investigate the effect of GECS after DVT. A literature search was performed by two independent searchers in order to identify randomised controlled trials on the effect of GECS in preventing recurrent DVT and post-thrombotic syndrome. Four randomised trials, including 537 patients, were identified. Two of the studies demonstrated that below-knee GECS significantly reduced post-thrombotic syndrome during follow-up, while a smaller study showed equivocal results. GECS reduced the incidence of post-thrombotic syndrome from 54% to 25.2% [relative risk (RR) 0.47, 95% confidence interval (CI) 0.36-0.61] with the number needed to treat (NNT) being 4 (95% CI 2.7-5.0).The rate of recurrent asymptomatic DVT was also significantly reduced by GECS (RR 0.20, 95% CI 0.06-0.64; NNT 5); the reduction in symptomatic DVT was not significant (RR 0.79, 95% CI 0.50-1.26; NNT 34). In conclusion, there is level Ia evidence to suggest that GECS can significantly reduce the incidence of post-thrombotic syndrome (PTS) after DVT, and therefore these should be routinely prescribed. The evidence for recurrent DVT is less conclusive. Further research is needed towards standardising PTS diagnostic criteria and evaluating more effective preventive measures after DVT.

Keywords

Graduated elastic compression stockings - recurrent deep vein thrombosis - venous thromboembolism - post-thrombotic syndrome - prevention
 

  • References

  • 1 Ziegler S, Schillinger M, Maca TH. et al. Postthrombotic syndrome after primary event of deep venous thrombosis 10 to 20 years ago. Thromb Res 2001; 101: 23-33.
    CrossrefPubMedSearch in Google Scholar
  • 2 Partsch H, Blättler W. Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. J Vasc Surg 2000; 32: 861-9.
    CrossrefPubMedSearch in Google Scholar
  • 3 Motykie GD, Caprini JA, Arcelus JI. et al. Evaluation of therapeutic compression stockings in the treatment of chronic venous insufficiency. Dermatol Surg 1999; 25: 116-20.
    CrossrefPubMedSearch in Google Scholar
  • 4 Noyes LD, Rice JC, Kerstein MD. Hemodynamic assessment of high-compression hosiery in chronic venous disease. Surgery 1987; 102: 813-5.
    PubMedSearch in Google Scholar
  • 5 Christopoulos DG, Nicolaides AN, Szendro G. et al. Air-plethysmography and the effect of elastic compression on venous hemodynamics of the leg. J Vasc Surg 1987; 05: 148-59.
    CrossrefPubMedSearch in Google Scholar
  • 6 Coleridge-Smith PD, Hasty JH, Scurr JH. Deep vein thrombosis: effect of graduated compression stockings on distension of the deep veins of the calf. Br J Surg 1991; 78: 724-6.
    CrossrefPubMedSearch in Google Scholar
  • 7 Belcaro G, Laurora G, Cesarone MR. et al. Prophylaxis of recurrent deep venous thrombosis A randomized, prospective study using indobufen and graduated elastic compression stockings. Angiology 1993; 44: 695-9.
    CrossrefPubMedSearch in Google Scholar
  • 8 Brandjes DP, Buller HR, Heijboer H. et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349: 759-62.
    CrossrefPubMedSearch in Google Scholar
  • 9 Ginsberg JS, Hirsh J, Julian J. et al. Prevention and treatment of postphlebitic syndrome: results of a 3-part study. Arch Intern Med 2001; 161: 2105-9.
    CrossrefPubMedSearch in Google Scholar
  • 10 Prandoni P, Lensing AW, Prins MH. et al. Belowknee elastic compression stockings to prevent the postthrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004; 141: 249-56.
    CrossrefPubMedSearch in Google Scholar
  • 11 Villalta S, Bagatella P, Piccioli A. et al. Assessment of validity and reproducibility of a clinical scale for the post-thrombotic syndrome. Haemostasis 1994; 24 (Suppl. 01) 157 (Abstract).
    PubMedSearch in Google Scholar
  • 12 Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet 1999; 353: 1167-73.
    CrossrefPubMedSearch in Google Scholar
  • 13 Porter JM, Moneta GL. International Consensus Committee on Chronic Venous Disease Reporting standards in venous disease: an update. J Vasc Surg 1995; 21: 635-45.
    CrossrefPubMedSearch in Google Scholar
  • 14 Rutherford RB, Padberg Jr FT, Comerota AJ. et al. Venous severity scoring: an adjunct to venous outcome assessment. J Vasc Surg 2000; 31: 1307-12.
    CrossrefPubMedSearch in Google Scholar
  • 15 Kahn SR, Desmarais S, Ducruet T. et al. Comparison of the Villalta and Ginsberg clinical scales to diagnose the post-thrombotic syndrome: correlation with patient-reported disease burden and venous valvular reflux. J Thromb Haemost 2006; 04: 907-8.
    CrossrefPubMedSearch in Google Scholar
  • 16 British National Formulary No 49 (March 2005). British Medical Association and the Royal Pharmaceutical Society of Great Britain. 2005. London.:
    Search in Google Scholar
  • 17 Franks PJ, Oldroyd MI, Dickson D. et al. Risk factors for leg ulcer recurrence: a randomized trial of two types of compression stocking. Age Ageing 1995; 24: 490-4.
    CrossrefPubMedSearch in Google Scholar
  • 18 Kalodiki EP, Hoppensteadt DA, Nicolaides AN. et al. Deep venous thrombosis prophylaxis with low molecular weight heparin and elastic compression in patients having total hip replacement A randomised controlled trial. Int Angiol 1996; 15: 162-8.
    PubMedSearch in Google Scholar
  • 19 Jeffery PC, Nicolaides AN. Graduated compression stockings in the prevention of postoperative deep vein thrombosis. BrJ Surg 1990; 77: 380-3.
    CrossrefPubMedSearch in Google Scholar
  • 20 Stain M, Schonauer V, Minar E. et al. The postthrombotic syndrome: risk factors and impact on the course of thrombotic disease. JThromb Haemost 2005; 03: 2671-6.
    PubMedSearch in Google Scholar
  • 21 Lord RS, Hamilton D. Graduated compression stockings (20-30 mmHg) do not compress leg veins in the standing position. ANZ J Surg 2004; 74: 581-5.
    CrossrefPubMedSearch in Google Scholar
  • 22 Merrett ND, Hanel KC. Ischaemic complications of graduated compression stockings in the treatment of deep venous thrombosis. Postgrad Med J 1993; 69: 232-4.
    CrossrefPubMedSearch in Google Scholar
  • 23 Buller HR, Agnelli G, Hull RD. et al. Antithrombotic therapy for venous thromboembolic disease. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (Suppl. 03) 401S-28S.
    CrossrefPubMedSearch in Google Scholar
  • 24 Kolbach DN, Sandbrink MW, Hamulyak K. et al. Non-pharmaceutical measures for prevention of postthrombotic syndrome. Cochrane Database Syst Rev 2004; 01: CD004174.
    PubMedSearch in Google Scholar
  • 25 Oxford Centre for Evidence-based Medicine Levels of Evidence. Available at http://www.cebm.net/levels_of_evidence.asp
    PubMed