de Moraes Silva MA, Nelson A, Bell-Syer SE, Jesus-Silva SG, Miranda F Jr, et al.
The Cochrane database of systematic reviews. Date of publication 2024 Mar 7;volume 3(3):CD002303.
1. Cochrane Database Syst Rev. 2024 Mar 7;3(3):CD002303. doi:
10.1002/14651858.CD002303.pub4.
Compression for preventing recurrence of venous ulcers.
de Moraes Silva MA(1)(2), Nelson A(3), Bell-Syer SE(4), Jesus-Silva SG(5),
Miranda F Jr(6).
Author information:
(1)Interdisciplinary Surgical Science Program, Universidade Federal de São Paulo
(UNIFESP), São Paulo, Brazil.
(2)Vascular Surgery, Hospital de Clinicas de Itajuba - MG, Itajuba, Brazil.
(3)School of Health and Life Sciences, Glasgow Caledonian University, Glasgow,
UK.
(4)Department of Health Sciences, University of York, York, UK.
(5)Vascular and Interventional Radiology Department, Itajubá Clinics Hospital,
Itajubá, Brazil.
(6)Division of Vascular and Endovascular Surgery, Department of Surgery,
Paulista School of Medicine - Federal University of São Paulo, São Paulo,
Brazil.
Update of
Cochrane Database Syst Rev. 2014 Sep 09;(9):CD002303. doi:
10.1002/14651858.CD002303.pub3.
BACKGROUND: Up to 1% of adults will have a leg ulcer at some time. Most leg
ulcers are venous in origin and are caused by high pressure in the veins due to
blockage or damaged valves. Venous ulcer prevention and treatment typically
involves the application of compression bandages/stockings to improve venous
return and thus reduce pressure in the legs. Other treatment options involve
removing or repairing veins. Most venous ulcers heal with compression therapy,
but ulcer recurrence is common. For this reason, clinical guidelines recommend
that people continue with compression treatment after their ulcer has healed.
This is an update of a Cochrane review first published in 2000 and last updated
in 2014.
OBJECTIVES: To assess the effects of compression (socks, stockings, tights,
bandages) for preventing recurrence of venous leg ulcers.
SEARCH METHODS: In August 2023, we searched the Cochrane Wounds Specialised
Register, CENTRAL, MEDLINE, Embase, three other databases, and two ongoing
trials registries. We also scanned the reference lists of included studies and
relevant reviews and health technology reports. There were no restrictions on
language, date of publication, or study setting.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) that
evaluated compression bandages or hosiery for preventing the recurrence of
venous ulcers.
DATA COLLECTION AND ANALYSIS: At least two review authors independently selected
studies, assessed risk of bias, and extracted data. Our primary outcome was
reulceration (ulcer recurrence anywhere on the treated leg). Our secondary
outcomes included duration of reulceration episodes, proportion of follow-up
without ulcers, ulceration on the contralateral leg, noncompliance with
compression therapy, comfort, and adverse effects. We assessed the certainty of
evidence using GRADE methodology.
MAIN RESULTS: We included eight studies (1995 participants), which were
published between 1995 and 2019. The median study sample size was 249
participants. The studies evaluated different classes of compression (UK class 2
or 3 and European (EU) class 1, 2, or 3). Duration of follow-up ranged from six
months to 10 years. We downgraded the certainty of the evidence for risk of bias
(lack of blinding), imprecision, and indirectness. EU class 3 compression
stockings may reduce reulceration compared with no compression over six months
(risk ratio (RR) 0.46, 95% confidence interval (CI) 0.27 to 0.76; 1 study, 153
participants; low-certainty evidence). EU class 1 compression stockings compared
with EU class 2 compression stockings may have little or no effect on
reulceration over 12 months (RR 1.70, 95% CI 0.67 to 4.32; 1 study, 99
participants; low-certainty evidence). There may be little or no difference in
rates of noncompliance over 12 months between people using EU class 1 stockings
and people using EU class 2 stockings (RR 1.22, 95% CI 0.40 to 3.75; 1 study, 99
participants; low-certainty evidence). UK class 2 hosiery compared with UK class
3 hosiery may be associated with a higher risk of reulceration over 18 months to
10 years (RR 1.55, 95% CI 1.26 to 1.91; 5 studies, 1314 participants;
low-certainty evidence). People who use UK class 2 hosiery may be more compliant
with compression treatment than people who use UK class 3 hosiery over 18 months
to 10 years (RR for noncompliance 0.69, 95% CI 0.49 to 0.99; 5 studies, 1372
participants; low-certainty evidence). There may be little or no difference
between Scholl UK class 2 compression stockings and Medi UK class 2 compression
stockings in terms of reulceration (RR 0.77, 95% CI 0.47 to 1.28; 1 study, 166
participants; low-certainty evidence) and noncompliance (RR 0.97, 95% CI 0.84.1
to 12; 1 study, 166 participants; low-certainty evidence) over 18 months. No
studies compared different lengths of compression (e.g. below-knee versus
above-knee), and no studies measured duration of reulceration episodes,
ulceration on the contralateral leg, proportion of follow-up without ulcers,
comfort, or adverse effects.
AUTHORS' CONCLUSIONS: Compression with EU class 3 compression stockings may
reduce reulceration compared with no compression over six months. Use of EU
class 1 compression stockings compared with EU class 2 compression stockings may
result in little or no difference in reulceration and noncompliance over 12
months. UK class 3 compression hosiery may reduce reulceration compared with UK
class 2 compression hosiery; however, higher compression may lead to lower
compliance. There may be little to no difference between Scholl and Medi UK
class 2 compression stockings in terms of reulceration and noncompliance. There
was no information on duration of reulceration episodes, ulceration on the
contralateral leg, proportion of follow-up without ulcers, comfort, or adverse
effects. More research is needed to investigate acceptable modes of long-term
compression therapy for people at risk of recurrent venous ulceration. Future
trials should consider interventions to improve compliance with compression
treatment, as higher compression may result in lower rates of reulceration.
Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.
DOI: 10.1002/14651858.CD002303.pub4
PMCID: PMC10919450
PMID: 38451842 [Indexed for MEDLINE]
Conflict of interest statement: MAMS: works as a health professional.
AN: was
involved in a study that is included in this review (Nelson 2006), but was not
involved in study eligibility decisions, extracting data, carrying out the risk
of bias assessment for, or performing GRADE assessments of this study for this
updated version. AN was an Editor with Cochrane Wounds, but was not involved in
the editorial process relating to this review update.
SEMBS: none known.
SGJS:
works as a health professional.
FMJ: none known.
