Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal

Abstract. Background: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. Methods: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. Results: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. Conclusions: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.

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Validation of the LET classification

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515569133 ◽

2015 ◽

Vol 30 (1_suppl) ◽

pp. 14-19 ◽

Cited By ~ 19

Author(s):

RHW Strijkers ◽

CWKP Arnoldussen ◽

CHA Wittens

Keyword(s):

Quality Of Life ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Odds Ratio ◽

Original Data ◽

Self Assessment ◽

Post Thrombotic Syndrome ◽

Thrombus Removal ◽

Disease Specific

Introduction Acute thrombus removal therapies may reduce post-thrombotic syndrome in certain deep venous thrombosis patients. The LET classification is designed to identify patients at high risk for developing post-thrombotic syndrome in the acute phase using thrombus location and extent. This study evaluates the use of the LET classification to predict post-thrombotic syndrome in a cohort of patients after deep venous thrombosis. Methods A cohort of 660 deep venous thrombosis patients was invited to participate and fill out a questionnaire with Quality of life questionnaires, basic information, a modified self-assessment version of the Villalta scale for post-thrombotic syndrome and potential confounders. Original data on thrombus extension was available, and the LET classes were determined. Obtained information was analysed using ANOVA and in a multiple logistic regression model to correct for confounders. All different LET classes were compared to post-thrombotic syndrome occurrence, post-thrombotic syndrome prediction and disease specific quality of life scores (VEINES-Sym/Qol). Results Three hundred and fifteen patients responded, and in 309 a post-thrombotic syndrome score was distilled. LET I,II,III ( n = 63) had an odds ratio of 3.4(1.2–9.2) for predicting severe post-thrombotic syndrome, and LET II ( n = 17) had an odds ratio of 5.1(1.3–20.8) compared to LET class I ( n = 97). Both the VEINES-Sym and VEINES-Qol score were significantly lower for LET I,II,III compared to LET I, and LET II compared to LET I. Conclusion The LET classification can be used to classify patients according to acute thrombus location and extent. Extensive and centrally located (LET I,II,III) deep venous thrombosis showed the highest probability in developing severe post-thrombotic syndrome and lower disease specific quality of life.

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Impact of graduated compression stockings on the prevention of post-thrombotic syndrome - results of a randomized controlled trial

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514544781 ◽

2014 ◽

Vol 30 (8) ◽

pp. 541-548 ◽

Cited By ~ 18

Author(s):

Arjun Jayaraj ◽

Mark Meissner

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Severity Score ◽

Scoring Systems ◽

Clinical Severity ◽

Compression Stockings ◽

Post Thrombotic Syndrome ◽

Clinical Severity Score ◽

Venous Clinical Severity Score ◽

Graduated Compression Stockings

Objective Post-thrombotic syndrome is a chronic complication of acute deep venous thrombosis in the lower extremity. The role of graduated compression stockings in the prevention of post-thrombotic syndrome has been studied with opinion being divided on the beneficial effects. We aim to answer this question with a randomized controlled study that uses multiple scoring instruments to assess post-thrombotic syndrome. Methods Sixty-nine consecutive patients with acute deep venous thrombosis diagnosed by duplex ultrasonography were randomized to treatment with graduated compression stockings or no graduated compression stockings. Venous Clinical Severity Score and Villalta-Prandoni Score, commonly used scoring systems, were used to appraise post-thrombotic syndrome at 3, 6, 12, 18, and 24 months following diagnosis of deep venous thrombosis. In both scoring systems, the individual either had post-thrombotic syndrome or no post-thrombotic syndrome. Cumulative incidence was computed using Kaplan–Meier analysis. Relative risk was assessed for age, obesity, varicose veins, and iliofemoral deep venous thrombosis. Results As measured by both Villalta-Prandoni Score and Venous Clinical Severity Score instruments, the graduated compression stockings group had a lower incidence of post-thrombotic syndrome compared to the control group, but only when one month was used as cut off time for the first diagnosis of post-thrombotic syndrome. When 6 or 12 months were used, there was no difference in the incidence of post-thrombotic syndrome between the two groups. The burden of post-thrombotic syndrome was significantly more when the Villalta-Prandoni Score instrument (∼75%) was used as compared to the Venous Clinical Severity Score instrument (∼30%) at 24 months’ follow-up. Obesity was the only statistically significant predictor for the development of post-thrombotic syndrome. Conclusion As assessed by both Villalta-Prandoni Score and Venous Clinical Severity Score instruments, use of graduated compression stockings does not reduce the incidence of post-thrombotic syndrome. There is a significant difference in the incidence post-thrombotic syndrome as detected by Villalta-Prandoni Score and Venous Clinical Severity Score instruments with incidence of post-thrombotic syndrome dependent on instrument and cut off time interval used to assess post-thrombotic syndrome. However, larger prospective studies are required to confirm these differences.

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Dual and Balloon-Assisted AngioJet Thrombectomy for Iliofemoral Deep Venous Thrombosis

10.1093/med/9780199986071.003.0038 ◽

2018 ◽

Author(s):

Zubin Irani ◽

Sara Zhao

Keyword(s):

Pulmonary Embolism ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Mechanical Thrombectomy ◽

Post Thrombotic Syndrome ◽

Thrombus Removal ◽

Phlegmasia Cerulea Dolens ◽

Extremity Veins

Lower extremity deep venous thrombosis (DVT) may be complicated by pulmonary embolism, post-thrombotic syndrome, and phlegmasia cerulea dolens. Due to these complications, the American Venous Forum now recommends thrombus removal for large or symptomatic thrombus burden. The AngioJet Solent Proxy and Omni thrombectomy sets are indicated for use in iliofemoral and lower extremity veins with a diameter ≥3 mm. The device has quickly become a preferred device among the available mechanical thrombectomy options. The AngioJet system has been demonstrated as both efficacious and safe as a method of thrombectomy in lower extremity DVT. This chapter discusses two techniques to utilize the AngioJet device in iliofemoral DVT.

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A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb

Phlebology The Journal of Venous Disease ◽

10.1177/0268355518772760 ◽

2018 ◽

Vol 34 (2) ◽

pp. 115-127 ◽

Cited By ~ 7

Author(s):

Mohamed AH Taha ◽

Andrew Busuttil ◽

Roshan Bootun ◽

Alun H Davies

Keyword(s):

Quality Of Life ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Secondary Patency ◽

Stent Patency ◽

Venous Stenting ◽

Post Thrombotic Syndrome ◽

Thrombus Removal ◽

Therapy Quality

Objectives The aim is to evaluate venous stent patency, the development of post-thrombotic syndrome, recurrence, quality of life and the optimal post-procedural anticoagulation regimen in the treatment of iliofemoral deep venous thrombosis. Method and results EMBASE and Medline databases were interrogated to identify studies in which acute deep venous thrombosis patients were stented. Twenty-seven studies and 542 patients were identified. Primary, assisted primary and secondary patency rates 12 months after stent placement ranged from 74 to 95, 90 to 95 and 84 to 100%, respectively. The observed post-thrombotic syndrome rate was 14.6%. The incidence of stent re-thrombosis was 8%. In 26% of studies, patients received additional antiplatelet therapy. Quality of life questionnaires employed in 11% of studies, demonstrating an improvement in the chronic venous insufficiency questionnaire (22.67 ± 3.01 versus 39.34 ± 6.66). Conclusion Venous stenting appears to be an effective adjunct to early thrombus removal; however, further studies are needed to identify optimal anticoagulant regimen and effect on quality of life.

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