Clinical Question: Can off-the-shel...

Clinical Question: Can off-the-shelf compression stockings impede post-thrombotic syndrome in patients with a proximal astute venous thrombosis (DVT)?

Setting: Outpatient (primary care)

meditation Design: Randomized controlled trial (nonblinded)

Allocation: Concealed

Synopsis: The authors of this inquiry enrolled 180 consecutive patients who not absented with a first episode of symptomatic proximal DVT and received conventional anticoagulant treatment. onward discharge, the patients were given nothing or below-the-knee elastic compression stockings to wear at least during the day for a minimum of couple years. The stockings provided 30 to 40 mm Hg of pres-sure at the ankle and were available in five sizes. The investigators, who were unaware of treatment assignment, evaluated the patients each three months for at least sum of two units years and up to five years.

Using a self-develop and validated 33-point scale, investigators assigned a diagnosis of "mild" post-thrombotic syndrome to patients with scores of 5 to 14 upon two consecutive visits, and "severe" post-thrombotic syndrome if they had a score of 15 or greater in succession two consecutive examinations. Post-thrombotic syndrome occurr in 491 percent of patients without stockings, on the contrary only 24.5 percent of patients using the stockings (adjusted hazard ratio = 049; 95 percent confidence interval [CI], 029 to 084; P = 011) through two years, one additional episode of the syndrome was avoided for each four patients who wore the stockings (number straited to treat = 4; 95 percent CI = 23 to 189)

Bottom Line: Post-thrombotic symptoms similar as discomfort, swelling, and skin discoloration be found in up to one third of patients who have experienced a symptomatic proximal DVT Use of below-the-knee graded compression stockings decreases the cumulative incidence of post-thrombotic symptoms by way of 50 percent over two years. Patients with a thrombosis should be advised to purchase these stockings following acute treatment. The stockings should be replaced each six months. (Level of Evidence: 2b)

subject of attention Reference: Prandoni P, et al. Below-knee elastic compression stockings to hinder the post-thrombotic syndrome: a randomized, controll trial. Ann Intern M August 17 2004;141:249-56

Used with permission from Shaughnessy AF. Compression stockings obstruct post-thrombotic syndrome. Accessed online November 1 2004 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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