Clinical research studies
Acute venous thromboembolism
Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal

https://doi.org/10.1016/j.jvsv.2021.06.023Get rights and content

Abstract

Objective

To evaluate the effectiveness of elastic compression stockings (ECS) in prevention of post-thrombotic syndrome (PTS) in patients suffering from proximal deep venous thrombosis (DVT) who did not undergo thrombus removal procedures.

Methods

In this randomized trial, patients with Iliofemoral venous thrombosis (IFDVT) and femoral-popliteal venous thrombosis who had not undergone thrombus removal procedures were screened at a single medical institution between December 2016 and June 2018. These patients were randomly assigned as an ECS group (wear ECS) and control group (not wear ECS). The primary end point was the incidence of PTS based on the Villalta scale at 24 months. The secondary end points included patient quality of life and symptom severity based on the VEINES-QoL/Sym questionnaire. Recurrent DVT in the same limb, compliance with ECS use, and other adverse events were also recorded. A logistic regression analysis was also performed to determine risk factors of PTS.

Results

Two hundred thirty-two patients were included in this study. One hundred thirteen patients were in the ECS group and 119 in the control group. The incidence of PTS was 42.0% in the ECS group and 57.8% in the control group at 24 months (risk ratio [RR], 0.726; 95% confidence interval [CI] 0.547-0.964; P = .024). The VEINES-QoL score was 63.7 ± 4.6 in the ECS group, which was higher than in the control group (60.6 ± 6.9; P < .001). Moreover, the VEINES-Sym scores revealed that patients in the ECS group reported better symptom relief than those in the control group (45.8 ± 5.1 vs 43.8 ± 6.1; P = .014). According to Logistic regression analysis of the entire cohort, IFDVT was a risk factor for PTS (RR, 2.253; 95% CI, 1.136-4.468) and high compliance with the use of ECS was protect factor (RR, 0.516; 95% CI, 0.277-0.961).

Conclusions

These results suggest that ECS can prevent PTS in patients with IFDVT and femoral popliteal venous thrombosis who do not undergo thrombus removal procedures.

Section snippets

Study participants

Patients with IFDVT and Fem-pop DVT were screened at a single medical institution between December 2016 and June 2018. The inclusion criteria for this study were patients who were diagnosed with a compression ultrasound-proven DVT involved in popliteal or more proximal deep-leg veins for less than 28 days and had not received a thrombus removal procedure. Patients with following conditions were exclude from this study: recurrent ipsilateral DVT, isolated calf DVT, planning to receive or had

Results

During the enrollment period, 438 patients with DVT were screened for eligibility. Two hundred three patients were excluded owing to failure to meet the inclusion criteria (116 patients) or refusing to participation (87 patients). A flowchart was shown in the Fig according to the CONSORT statement. Finally, 113 patients were included in the ECS group and 119 patients were included in the control group. Of the 232 patients, 100 (48.2%) were male. The mean age was 59.2 ± 13.2 years. Seventy-five

Discussion

The results of this study demonstrated that wearing ECS decreased the incidence of PTS at 24 month after a proximal DVT in patients who were not available for or could not undergo thrombus removal procedures. Using ECS also improved patients' quality of life. However, ECS use did not decrease the recurrence of DVT.

Patients with proximal DVT are more likely to develop PTS compared with those suffering from calf DVT only.17 Thrombus removal can decrease the incidence of PTS. The CaVenT study

Conclusions

ECS use can decrease the incidence of PTS for up to 2 years and improve patient quality of life. The results of the current study suggest that using ECS could prevent PTS in patients with IFDVT and Fem-pop DVT who were not available for or could not undergo thrombus removal procedures. Long-term follow-up and objective assessment of compliance are necessary to evaluate the true therapeutic effect of ECS.

Author contributions

Conception and design: KY

Analysis and interpretation: XY, RW, XL

Data collection: XY, XZ, MY

Writing the article: XY, XZ, MY

Critical revision of the article: RW, XL, KY

Final approval of the article: XY, XZ, MY, RW, XL, KY

Statistical analysis: XY, RW

Obtained funding: KY, XL, XY, XZ

Overall responsibility: KY

XY and XZ contributed equally to this article and share co-first authorship

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    • Cited by (0)

    Supported by the Science and Technology Committee of Shanghai [19411966100], National Science Foundation of China [81700432, 81870346], Clinical Research Program of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine [JYLJ019], and Shanghai Sailing Program (20YF1423800).

    Author conflict of interest: none.

    The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

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    © 2021 by the Society for Vascular Surgery. Published by Elsevier Inc.