Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis

VASA ◽  
2016 ◽  
Vol 45 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Jakob Martin Burgstaller ◽  
Johann Steurer ◽  
Ulrike Held ◽  
Beatrice Amann-Vesti
Keyword(s):  
Systematic Review ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Cochrane Library ◽  
Compression Stockings ◽  
Post Thrombotic Syndrome ◽  
Study Results ◽  
Preventive Efficacy ◽  
One Year ◽  
The Cochrane Library

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.

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

2014 ◽  
Vol 30 (8) ◽  
pp. 541-548 ◽  
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.

scholarly journals Cost-Related Medication Nonadherence in Canada: A Systematic Review of Prevalence, Predictors, and Clinical Impact

2020 ◽  
Author(s):  
Anne Marie Holbrook ◽  
Mei Wang ◽  
Munil Lee ◽  
Zhiyuan Chen ◽  
Michael Garcia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Low Income ◽  
Original Data ◽  
Population Based ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Sampling Frame ◽  
One Year ◽  
The Cochrane Library

Abstract Background Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, is unclear. Objectives Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes.Methods We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools.Results: Twenty-six studies of varying quality (n=483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1% to 10.2%. Factors predicting CRNA included high out of pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at one year. Conclusion: CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.

Clinical and anatomical findings of acute iliofemoral deep venous thrombosis

2004 ◽  
Vol 19 (1) ◽  
pp. 42-46 ◽  
Author(s):  
J Saarinen ◽  
M Anturaniemi ◽  
M Heikkinen ◽  
V Suominen ◽  
J-P Salenius
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Malignant Disease ◽  
Clinical Findings ◽  
Coagulation Disorder ◽  
Invasive Treatment ◽  
Anatomical Features ◽  
Consecutive Sample ◽  
Post Thrombotic Syndrome ◽  
One Year

Objective: To observe the clinical and anatomical features of acute iliofemoral deep venous thrombosis (DVT). Methods: A consecutive sample of phlebographically confirmed DVT cases during a 25-month period were retrospectively assessed. There were 390 DVT cases, including 73 patients with iliofemoral DVT. The phlebograms of iliofemoral DVTs were reviewed and the location of the thrombus mapped. The patients' files were completely reviewed in all patients with DVT, including concomitant diseases and mortality after the diagnosis of DVT. Results: The average age of the patients with iliofemoral DVT was 63 years compared with 57 years in the cases of infrainguinal DVT ( P<0.005). Left : right-ratio was 2.43 in iliofemoral DVTs, and 1.42 in infrainguinal cases ( P<0.005). Iliofemoral DVT cases were multisegmental (from calf into iliac veins) in 92% of the legs. The aetiology of iliofemoral DVT was idiopathic in 55%, surgery in 14%, malignancy in 14%, immobilization in 10%, trauma in 5%, coagulation disorder in 1% and pregnancy in 1% of the cases. No concomitant diseases were noted in 32% of the patients with iliofemoral DVT, and the corresponding finding in the subgroup of infrainguinal DVTs was 57%. The incidence of death within one-year was 18% and 8% in the subgroups of iliofemoral and infrainguinal DVT. In patients with a combination of iliofemoral DVT and malignancy,the incidence of death within one-year was 80%. Conclusions: According to anatomical findings iliofemoral DVT is typically left-sided and multisegmental. However, clinical findings show that patients with this condition are relatively aged, and the frequency of concomitant diseases is high. The prognosis among the patients with pre-existing malignant disease was very poor. Prevention of post-thrombotic syndrome by using invasive treatment should be considered only in selected cases.

scholarly journals Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027922 ◽  
Author(s):  
Ferozkhan Jadhakhan ◽  
Oana C Lindner ◽  
Amy Blakemore ◽  
Elspeth Guthrie
Keyword(s):  
Systematic Review ◽  
Healthcare Costs ◽  
Meta Analysis ◽  
Medically Unexplained Symptoms ◽  
Cochrane Library ◽  
Persistent Symptoms ◽  
Study Results ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The Cochrane Library

IntroductionMedically unexplained symptoms (MUS) are common in primary-care and secondary-care settings. Persistent symptoms of MUS are associated with a variety of poor outcomes including increased disability, poor quality of life and high healthcare costs. The aim of this systematic review is to review the relevant literature to determine the prevalence of MUS in patients who are high users of healthcare and/or who accrue high healthcare costs.Methods and analysisThis review will include studies with cases that are either high users of general healthcare or are patients who accrue high healthcare costs, aged ≥18 years and where a recognised measure of MUS, either a standardised clinical interview or questionnaire, was employed. The following citation databases MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and the Cochrane library will be systematically searched from inception to 30 June 2018. The Cochrane library was included because of the significant proportion of non-observational studies currently published in the database. The prevalence of MUS and associated disorders along with the costs or use of healthcare associated with the presence of MUS will be estimated with 95% CI. If possible, study results will be pooled into a meta-analysis. However, if heterogeneity is high, data analysis will be presented descriptively.Ethics and disseminationEthical approval is not required for this systematic review since only data from existing studies will be used. Results of this review will be disseminated in peer-reviewed publications and at national and international conferences.PROSPERO registration numberCRD42018100388

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