Azirar S, Appelen D, Prins MH, Neumann MH, de Feiter AN, Kolbach DN, et al.
The Cochrane database of systematic reviews. Date of publication 2019 Sep 18;volume 9(9):CD004177.
1. Cochrane Database Syst Rev. 2019 Sep 18;9(9):CD004177. doi:
10.1002/14651858.CD004177.pub2.
Compression therapy for treating post-thrombotic syndrome.
Azirar S(1), Appelen D, Prins MH, Neumann MH, de Feiter AN, Kolbach DN.
Author information:
(1)Department of Dermatology, Huidcentrum Limburg, Maastricht, Netherlands.
Update of
Cochrane Database Syst Rev. 2003;(4):CD004177.
BACKGROUND: Post-thrombotic syndrome (PTS) is a long-term complication of deep
vein thrombosis (DVT) characterised by chronic complaints such as oedema and
skin changes including; venous ectasia, varicose veins, redness, eczema,
hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in
the affected limb. These chronic complaints are the effects of venous outflow
restriction that can cause symptoms such as heaviness, itching, pain, cramps,
and paraesthesia. Twenty to fifty percent of people with DVT develop
post-thrombotic complications. Several non-pharmaceutical measures are used for
prevention of PTS during the acute phase of DVT. These include elevation of the
legs and compression therapy. There have been limited studies regarding the
effectiveness of compression therapy for prevention or treatment of PTS. As a
result, clinicians and guidelines differ in their assessment of compression
therapy during treatment of DVT and in the treatment of PTS. This is an update
of a review first published in 2003.
OBJECTIVES: To assess the effectiveness of compression therapy for treatment of
post-thrombotic syndrome, including elastic compression stockings and mechanical
devices compared with no intervention, placebo and with each other.
SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist
searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase
and CINAHL databases and World Health Organization International Clinical Trials
Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018.
SELECTION CRITERIA: We included trials that evaluated compression therapy for
the treatment of PTS. The primary outcomes were severity of PTS and adverse
effects. There were no restrictions on date or language. Two review authors (SA,
DNK) independently assessed whether potentially relevant studies met the
inclusion criteria.
DATA COLLECTION AND ANALYSIS: One review author extracted and summarised data
and one review author (DNK) verified them. We resolved disagreements by
discussion. We assessed methodological study quality with the Cochrane 'Risk of
bias' tool. We used GRADE to assess the overall certainty of the evidence
supporting the outcomes assessed in this review.
MAIN RESULTS: We identified four trials, with 116 participants, investigating
the effectiveness of compression therapy for treatment of PTS. The methodology
used by each trial was too heterogeneous to perform a meta-analysis, so we
reported our findings narratively.Two trials studied the effect of graduated
elastic compression stockings (GECS) on improvement of PTS symptoms. One study
reported beneficial haemodynamic effects, while the other found no benefits on
PTS severity compared to placebo (very low-certainty evidence). There was very
limited evidence available for adverse effects and quality of life (QoL). The
two studies did not report on compliance rates during the study period.Two
trials studied the effects of intermittent mechanical compression devices. Both
reported improvement in PTS severity (low-certainty evidence). Improvement of
the severity of PTS was defined by treatment 'success' or 'failure'. Only one
study comparing compression devices evaluated adverse effects and QoL. Although
9% of the participants experienced adverse effects such as leg swelling,
irritation, superficial bleeding, and skin itching (moderate-certainty
evidence), QoL was improved (moderate-certainty evidence). Studies did not
assess compliance using intermittent mechanical compression devices.None of the
studies evaluated patient satisfaction.
AUTHORS' CONCLUSIONS: There is very low-certainty evidence regarding the use of
GECS for treatment of PTS as assessed by two small studies of short duration.
One study reported beneficial haemodynamic effects, while one found no benefits
on PTS severity compared to control/placebo stockings. There is very limited
evidence for adverse effects, patient satisfaction, QoL, and compliance rates.
There is low-certainty evidence favouring use of intermittent pneumatic
compression devices compared to a control device for the treatment of severity
owing to different measurements used by the studies reporting on this outcome
and small studies of short duration. There is moderate-certainty evidence of
improved QoL but possible increased adverse effects related to compression
device use owing to small studies of short duration. High-certainty evidence to
support the use of compression therapy in prevention of PTS is lacking and any
conclusions drawn from current evidence should be interpreted with care. Further
research is needed to assess whether compression can result in long-term
reduction and relief of the symptoms caused by PTS, or prevent deterioration and
leg ulceration.
DOI: 10.1002/14651858.CD004177.pub2
PMCID: PMC6749555
PMID: 31531971 [Indexed for MEDLINE]
Conflict of interest statement: SA: none. DA: none. MHP: declared that his
institution received payments from companies involved in the development of
direct anticoagulants for the treatment of thrombosis (Daichi Sankyo, Pfizer,
Bayer, Sanofi, Boehringer Ingelheim). HAMN: none. AdF: none. DNK: none.
